Get Application For Out-of-province Coverage Certificate - Health And ... - Health Gov Nl

This guide provides clear and comprehensive instructions on how to complete the Application For Out-of-Province Coverage Certificate for the Newfoundland and Labrador Medical Care Plan online. Whether you are a student or a temporarily absent worker, this document is essential for obtaining medical coverage while outside the province.

Follow the steps to successfully complete the application form.

1. Click ‘Get Form’ button to obtain the application form and open it in the designated editor.
2. Fill in the personal information section, starting with the surname and all given names: first name and middle name. This ensures your application is correctly associated with your identity.
3. Enter your Medical Care Plan (MCP) card number in the specified field. If you do not have one, consult the program for guidance.
4. Provide your birth date in the format of YYYY-MM-DD. This helps verify your identity.
5. Complete the Newfoundland & Labrador home mailing address section, including street/P.O. Box, city/town, province, and postal code. Ensure accuracy to receive important correspondence.
6. Input your home telephone number, cell number, and email address to facilitate communication regarding your application.
7. In the address while outside Newfoundland & Labrador section, fill in the relevant address details for where you will be during your absence, including street/P.O. Box, city/town, province/state/country, and postal/zip code.
8. Provide the telephone number, cell number, and email address for your location while abroad.
9. Detail the absence from Newfoundland & Labrador, including your date of departure, expected date of return, and the reason for your absence.
10. If the applicant is under 16 years of age, ensure that a parent or legal guardian signs the declaration at the end of the form. They will also need to include the date of signing.
11. Review all information entered to confirm its accuracy and completeness.
12. Save the changes, download a copy for your records, print the form, or share it as necessary.

Take the first step to secure your out-of-province coverage by completing the application online today.