Permanent Move Outside British Columbia

This form must be submitted by the Account Holder in the event of a family move. If this form is submitted by a dependent on an account, coverage will be cancelled for that dependent only.

If you are moving within Canada, coverage is provided for the balance of the month in which you leave the province plus two consecutive months. If required, coverage may be extended for three extra months to cover you while in transit.

If you are moving outside Canada – coverage is provided for the balance of the month in which you leave the province.

If you have further questions about your MSP coverage and leaving BC permanently, contact Health Insurance BC at 1-800-663-7100 or 604-683-7151.


ACCOUNT INFORMATION

* indicates field is mandatory

Personal Health Number (PHN) of Account Holder
from BC Services Card/CareCard

OR

Personal Health Number of Dependent
from BC Services Card/CareCard

Surname*

Area Code (999)

Phone Number

(9999999)

E-mail Address (enables MSP to contact you if there is an error in processing your request)

NEW ADDRESS

Postal Box or Street Address*

Street Address

City*

Province* (if Canada)

   OR   State   

Country*

Postal Code* (if Canada)

  OR   Zip Code  

CHANGE of ADDRESS EFFECTIVE DATES

Date of Permanent Departure from BC*

Date of Arrival in new province or country


COMPLETE ONLY IF THE ACCOUNT HOLDER IS SUBMITTING THIS FORM

Please indicate if everyone on your account has moved out of BC with you (required if the account holder is submitting the address change).

YES  (no further information is required)

NO  (Please indicate below, the PHNs of everyone on the account, including the account holder, who HAS moved.)


Personal information is collected under the authority of the Medicare Protection Act and section 26 (a), (c) and (e) of the Freedom of Information and Protection of Privacy Act (“FOIPPA”). Information may be disclosed pursuant to section 33 of FOIPPA. If you have any questions about the collection and use of your personal information, please contact: Health Insurance BC Chief Privacy Office, PO Box 9035 STN PROV GOVT, Victoria, BC V8W 9E3 or call 604 683-7151 (Vancouver) or 1 800 663-7100 (toll-free).


Please only click the submit button once! A small delay afterwards is normal when submitting the form.


BC SERVICES CARD

The 10 digit number on the back of the BC Services Card (or front of the CareCard if you still have one) is your "Personal Health Number" (PHN). Enter all 10 digits without spaces or other characters.

BC Services Card BC Services Card back

 


HLTH 7063 - Last Revised: July 08, 2019