'Fill-and-Print' Notice of Change Form

This form is to be used for reporting the following:

• Change of address

• Leaving the province

• Addition of Dependant/Spouse

• Deletion of Dependant

Please read the disclaimer below. If you agree to the terms please click on 'I Accept' to proceed to the Notice of Change Form.

Disclaimer

The purpose for which this information is being collected is to enable Manitoba Health 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 representative at 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.

(NOTE:  You must have the Adobe Acrobat Reader (minimum Version 6.0) installed on your computer in order to proceed.)

I Accept

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