health
benefits

        
   
   
 
 
 
 
 
   
 
 
 
 
 
 
   
 

MSP Out-of-Country Claim Form

Use
If you are covered for the Medical Services Plan of BC (MSP) under your Health Benefit Plan, use the MSP Out-of-Country Claim Form to submit claims for medical expenses incurred outside of Canada.

All medical expenses incurred outside of Canada must be submitted to MSP prior to being submitted under your Health Benefit Plan.


Information Needed to Complete the Form
In addition to the Member's personal information, additional information is required to complete the form, including:

  • Information on the claimant's medical expenses
  • All original receipts or bills
Additional information to complete the form is listed on Section D of the form. Please follow the instructions on the form.


Notes
Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be forwarded directly to MSP as per Section D of the form.


Plan Administrator
D.A. Townley & Associates Ltd.
101 – 4190 Lougheed Highway
Burnaby, BC V5C 6A8

Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136

Email
 

Form Link
 
MSP Out-of-Country Claim Form
( PDF - 121 Kb)
 
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