Applying for Temporary Absence from the NWT

Applying for Temporary Absence from the NWT

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:
    • Medical
      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.
    • School
      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).
    • Work
      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.
    • Snowbirds
      • 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.
    • Other
      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



  • 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

Bag #9

Inuvik, NT X0E 0T0

Fax to: 1-867-777-3197

Email to:

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