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.

When a person leaves BC to reside elsewhere in Canada, benefits are provided for the balance of the month of departure plus two consecutive months. If required, coverage may be extended for up to three additional months to provide benefits while in transit.

Note: If a family moves to another part of Canada and one spouse leaves in advance of the other (but within one year), this form should be completed based on the later date of departure from BC and arrival in the new province. Coverage for the family will end based on the later move.

When a person leaves the province to reside outside Canada, coverage will be provided for the balance of the month of departure.

Upon receipt of notification of a person's permanent move outside BC, MSP benefits will be cancelled accordingly.

Some fields are (required) to submit this form. Please fill out this form as completely as possible and check your information before submitting.

Please contact the Medical Services Plan at 1-800-663-7100 or 604-683-7151 if there are exceptional circumstances which cannot be recorded by this form.


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.)


The personal information you will provide will be collected for the following purposes: Enrolment in the Medical Services Plan; and, Application for a BC Services Card and its authorized programs. 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 ("FIPPA"). Information may be disclosed pursuant to section 33 of FIPPA. 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/CARECARD

The 10 digit number on the back of the BC Services Card or front of the CareCard 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: February 25, 2019