Request for Prior Approval for Full Payment of Insured Out-of-Country Health Services

Please be advised, effective July 15, 2024 this form will be removed from the Central Forms Repository. A new, electronic form (on00134) to request consideration of funding for out-of-country health services was implemented April 15, 2024 and is available at: https://forms.mgcs.gov.on.ca/en/dataset/on00314

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Form Number 014-4520-84
Title Request for Prior Approval for Full Payment of Insured Out-of-Country Health Services
Description Please be advised, effective July 15, 2024 this form will be removed from the Central Forms Repository. A new, electronic form (on00134) to request consideration of funding for out-of-country health services was implemented April 15, 2024 and is available at: https://forms.mgcs.gov.on.ca/en/dataset/on00314