Please read the Disclaimer and Privacy Statement below which applies to all Manitoba Health, Seniors and Active Living forms.
This form is used for the following purposes:
See FAQ for more information.
(Fill and Print Version - the "Fill and Print" form must be completed online, then printed and forwarded to Manitoba Health via mail, fax, or e-mail for processing)
NOTE: Based on the language settings of your computer, you may get error messages. The form is still functional, however you can also access the Print and Fill version.
This form is for the purpose of notifying Manitoba Health, Seniors and Active Living of your:
See FAQ for more information.
(Fill and Submit Version - the "Fill and Submit" form is completed online, submitted electronically to Manitoba Health for processing)
NOTE: Based on the language settings of your computer, you may get error messages. The form is still functional, however you can also access the Fill and Print version.
To make any other changes that are not listed above to your Manitoba Health card or for requests for continued health coverage for residents who will be temporarily outside of the province, please view other available forms below.
The purpose for which this information is being collected is to enable Manitoba Health, Seniors and Active Living to provide you with health coverage and/or service. If you require any further information about the collection of this information, please do not hesitate to contact a Manitoba Health, Seniors and Active Living representative at 204-786-7101 (toll free: 1-800-392-1207).
If you move to Manitoba from another province or territory in Canada, you may receive health care benefits (except personal care home benefits) from the first day of the third month after arrival. Until then you should maintain coverage with the health insurance plan of your previous home province or territory.
If you move to Manitoba from another country, you may receive health care benefits (except personal care home benefits) from the first day of your arrival provided you have the appropriate documentation, i.e., permanent resident status, proof of Canadian Citizenship if Returning Canadian, et cetera.
Eligibility for coverage is subject to The Health Services Insurance Act and Regulations.
The personal information you may be asked to provide is being collected under the authority of legislation and/or program policies under the jurisdiction of the Minister of Health. The information is required to provide health coverage and/or service and is protected under the protection and privacy provisions of The Freedom of Information and Protection of Privacy Act as well as The Personal Health Information Act.
If you have any questions about the collection of personal information, please contact:
Access and Privacy Coordinator
Manitoba Health, Seniors and Active Living
1st Floor Carlton Street,
Winnipeg, Manitoba CANADA
|For more information:|
Insured Benefits Branch
Residents within the province
from outside Winnipeg:
Questions? E-mail the Insured Benefits Branch
Residents should carry their registration certificate (Manitoba Health card) at all times to present when they or their dependents require health services.