Who can apply for temporary absence from the NWT?
- Residents who have a valid NWT Health Care Card, and plan to be out of the NWT for more than 90 days.
Submitting the temporary absence form will help avoid delays in payment for any necessary medical services that you may receive while you are temporarily out-of-territory or out-of-country.
How to apply for Temporary Absence?
- Complete and submit the Temporary Absence Form.
- Attach the following supporting documentation to the Temporary Absence Form:
Provide a copy of the medical referral or letter from your health care provider that includes the length of time you will be absent from the NWT for medical reasons.
Provide a copy of your Acceptance Letter with your course outline or a document from the Registrar’s Office confirming that you are going to post-secondary school full-time (as defined by the school).
Provide your employer’s name, address and phone/fax number as a contact reference.
- High-Performance Athletes
Provide either a document showing that you have received a grant from the NWT High-Performance Athlete Program, or a letter from the National Sporting Organization (NSO) or from a certified NSO coach.
- Provide a copy of your income tax form (blackout personal financial information); and
- A statutory declaration affirming that you are physically present in the NWT for at least 153 days a year and have not established permanent residency elsewhere.
If you plan on being out of the NWT for over three consecutive months, contact Health Services Administration office to see if you need to provide documentation to support your Temporary Absence Form
To maintain your health coverage, submit a Temporary Absence Form if you plan to be outside of the NWT for more than 90 days.
- A valid NWT Health Care Card
- Temporary Absence Form
Available at the Health Services Administration Office.
- There is no fee.
Contact this Service
Phone: 1-800-661-0830 (toll free)
Hours: 9:00 AM – 4:30 PM (Monday to Friday, closed statutory holidays)
Sending the Completed Form…
Health Services Administration
Department of Health and Social Services
Inuvik, NT X0E 0T0
Fax to: 1-867-777-3197
Email to: firstname.lastname@example.org