APPLICATION FOR NEWFOUNDLAND AND LABRADOR HEALTH CARE COVERAGE

Microsoft Word - 2020-06-18 App for MCP Coverage.doc APPLICATION FOR NEWFOUNDLAND AND LABRADOR HEALTH CARE COVERAGE Health and Community Services Medical Care Plan DO NOT ENTER TEXT ON THIS FORM WHEN IT IS OPEN IN A WEB BROWSER SAVE IT TO YOUR COMPUTER FIRST AND OPEN IT FROM THERE PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THE APPLICATION ON THE REVERSE • If you are applying for cover. [...] WAITING PERIOD If you are moving permanently to Newfoundland and Labrador from another Canadian province or territory you will be covered by your previous Plan for the remainder of the month you arrive in Newfoundland and Labrador plus the following two months. [...] In order to allow sufficient time for administration of the change in coverage from your previous Plan to MCP you should apply for MCP coverage immediately upon arrival in Newfoundland and Labrador. [...] See instructions on reverse side of SECTION 6 this form.) IT IS AN OFFENCE TO GIVE FALSE INFORMATION FOR THE PURPOSE OF OBTAINING COVERAGE UNDER THE NEWFOUNDLAND & LABRADOR MEDICAL CARE PLAN I hereby declare that I am the person named on the form, the information given is correct and the person(s) listed on this form are residents of Newfoundland and Labrador. [...] Electronic or Written Signature of Applicant: Date: PRIVACY NOTICE: The Newfoundland and Labrador Medical Care Plan (MCP) collects personal health information under the authority of the Medical Care and Hospital Insurance Act.