March 1, 2023

To: Urban/RSMC’s members,

Updated January 1, 2023

Plan(s) it applies to:

  • Extended health Care Plan

You use it to:

Use this form to request coverage of a drug that is not automatically covered under your drug plan. Provide the requested information to ensure timely assessment of your claim.

* Please click on the following link to view this revised list of prescriptions and the associated drug exception form for submission to Canada Life Assurance Company.