UHIP STATUS INQUIRY FORM

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All international students studying in Ontario must be covered by a provincial health insurance plan. As a full-time international student you are provided with the mandatory health insurance plan, known as the University Health Insurance Plan (UHIP), which pays for medical services such as seeing a doctor, hospital stays and treatment, exams, and emergency services.

The 12 months' cost of this insurance, currently $756, is usually charged to your student account (MyServiceHub) along with your tuition fees. You are covered from September 1 until August 31 of each academic year.

Please note that exchange international students are charged $252 per semester.

Email *

How were you able to access this form? *

Through the ISS Website

Through an email from the ISS office

Other

Please share your reason for completing this form: *

Student Application for UHIP

Dependent Application for UHIP

Extension of UHIP Coverage

OHIP Waiting Period Application (Canadian Citizens or Permanent Residents)

Change of Information (e.g. name, DOB)

Termination and Refund (please provide details in comment box at the end of the form)

General Question

Other:

PERSONAL INFORMATION

Family Name: *

First and Middle Names: *

Toronto Metropolitan Student ID #: *

Are you enrolled in classes for the current semester? *

Yes

Gender: *

This is solely for the purpose of completing your UHIP application with Cowan (insurance provider) as these are the only options on their system and it is required in order to complete your enrolment.

Female

Male

Non-binary

Undeclared

Date of Birth: *

YYYY

Level of Study: *

Undergraduate

Graduate

Exchange

TMU ELI /Foundation Programs

Other (Please indicate in comments near the end of the form)

Number of Persons Needing UHIP Coverage: *

One Person

Two Persons

Three or More Persons

Not applicable

Other:

Phone Number: *

Toronto Metropolitan Email Address: *

Effective Date of UHIP Coverage: *

The start date of your UHIP coverage e.g. September 1st, 2022. If you are a full-time international student registered in Fall 2022 your coverage will be effective from September 1st.

YYYY

Months of Coverage Required: *

The number of months that you will need for UHIP coverage. E.g. September to August is 12 months. Please note that UHIP is mandatory for full-time students (i.e. non-exchange) therefore indicating less than 12 months on this form would not change the mandatory 12 months of coverage.

Do you need to add dependents? *

Yes

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