Manitoba Health

eNotice of Change - Change of Address

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eNotice of Change - Change of Address

Please enter the required information as it appears on your Health Card. You can only request a change of address for yourself, your spouse (if on the same health card), a child under 18 (if you are the parent or guardian) or if you have legal decision making authority granted to you for the cardhold. Legal decision makers include Power of Attorney, Committee, or Substitute Decision-Maker. Include a copy of the legal decision making status if that document is not already on file with the department.

Submit only one Change of Address request per health card. The address change will apply to each family member listed on the health card.

If you need to make multiple changes to your health card:
Submit each change request that you need separately.
Then email insuredben@gov.mb.ca with all the confirmation numbers so we can process everything together.

Cardholder's Information

Registration Number

Personal Health Identification Number (PHIN) (9 digits)*

Contact Us if you cannot recall your Personal Health Identification Number or if you have questions about completing this form.

Primary Phone Number

Email Address

Last Name*

First Name*

Middle Name (optional)

Sex* Male Female Non-binary

Date of Birth*

Change of Address

Please check to make sure your address information is correct. Mistakes can lead to undeliverable mail, which could cause suspension of your health coverage.

New Address:

Apartment/Unit Number Street address/P.O Box:*

City/Town/Municipality*

Province

Postal Code*

The Mailing address is the same as the Residential Address.

New Mailing Address

Apartment/Unit Number Street address/P.O Box:*

City/Town/Municipality*

Province

Postal Code*

Form Completed By

Your request may be delayed or returned if it's not complete. Your processing time starts the day we receive your complete request.
Visit our website to view the expected processing time for received applications.

Last Name*

First Name*

Relationship to applicant* Self Power of Attorney/Substitute Decision Maker/Committeeship Holder Other

Date

By checking this box I certify that the information contained herein is true. Section 42 of the Health Services Insurance Act provides for a fine of up to $5000 for a person convicted of making false and misleading statements.*

Below is a summary of the changes you are requesting. Please review the changes to ensure it is accurate before submitting. If changes are required click the EDIT button to return to the form and make changes. When you have confirmed that the information in this summary is correct scroll to the bottom of the page and click the SUBMIT button to submit the form.

Note: Your application is not complete until you have received a confirmation number.

eNotice of Change - Change of Address

Cardholder's Information

Registration Number:

Personal Health Identification Number (PHIN):

Primary Phone Number:

Email Address:

Last Name:

First Name:

Middle Name:

Sex:

Date of Birth:

Change of Address

Apartment/Unit Number:

Street address/P.O Box:

City:

Province:

Postal Code:

Mailing Address

The Mailing Address is the same as the Current Address.

Apartment/Unit Number:

Street address/P.O Box:

City:

Province:

Postal Code:

Form Completed By

Last Name:

First Name:

Date:

By checking this box, I certify that I am completing this form as the cardholder or on behalf of someone who appears on my MB Health Card or for whom I have Power of Attorney. Section 42 of the Health Services Insurance Act provides for a fine of up to $5000 for a person convicted of making false and misleading statements.

After you click SUBMIT you will be directed to a CAPTCHA page. Once the CAPTCHA is completed successfully you will receive a Confirmation number for your submission, which indicates our office has received your request. Please make note of this confirmation number to reference when contacting Manitoba Health.