Travel Claims

All claims for the CUMIS Travel Insurance Program are administered by TIC Travel Insurance Coordinators Ltd. Claims and Emergency Assistance. Please contact them directly or download the appropriate form below and mail in to the address listed below.

Important: In the event of a medical emergency, TIC Emergency Assistance must be notified prior to any surgery being performed or within 24 hours of admission to a hospital. Emergency Medical Travel Assistance is available 24/7, by calling any of the following numbers:

Toll free within Canada/USA: 1-800-995-1662

Toll free International: 800-842-08420 or 00-800-842-08420 (if not available, please call collect)

Collect worldwide: 416-340-0049

Mailing Address:

TIC Claims
2100 - 250 Yonge St.
Toronto, ON, Canada M5B 2L7

E-mail: assist@travelinsurance.ca

Travel Claims Forms

Please note: Some of these claim forms are formatted for 8 ½ x 14 (legal) size paper. Printing on smaller paper sizes may result in formatting errors, however the forms are still valid for use as a claim form.

Hospital and Medical Claims

Alberta Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

British Columbia Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Health Insurance BC Out-of-Country Claim form(50 KB) 

Health Insurance BC Schedule A & B(284 KB) 

Manitoba Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

New Brunswick Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Newfoundland Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Application for Insurance Benefits(8 KB) 

Northwest Territories/Yukon/Nunavut Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Nova Scotia Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Ontario Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

OHIP Authorization and Release Form(63 KB) 

Prince Edward Island Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Quebec Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Application for Reimbursement and Power of Attorney(94 KB) 

Saskatchewan Residents

Emergency Hospital & Medical Insurance for Canadians(172 KB) 

Health Insurance of Saskatchewan Schedule A & B(285 KB) 

Trip Cancellation/Interruption Claims

Trip Cancellation & Interruption(226 KB) 

Baggage Claims

Baggage(136 KB) 

Flight Accident and AD&D Claims

Flight Accident and Accidental Death & Dismemberment(129 KB) 

Medical Certificates

Emergency Hospital & Medical for Canadians Medical Certificate(76 KB) 

Release of Information Forms

Agent Release Form - English(99 KB) 
Agent Release Form - French(153 KB) 

Third Party Release Form - English(98 KB)
Third Party Release Form - French(153 KB)  

Note: Presenting a false claim is a fraudulent act and will be reported to the Insurance Crime Prevention Bureau.