MEDOC® Supplemental Plan Change Form

We understand that plans change, so we’re making it easier for you to update your coverage online.

Use this form to change your Supplemental Plan trip dates for this year’s travel season, or downgrade to the Base Plan. We’ll process your request within 5 to 10 business days and reach out if necessary.

Please note, QCC members should call us at 1-866-606-3362 to make changes to their plans.

Member Details

The principal policyholder should fill out this section.

First name

Last name

Street address

City

Province

Postal code

Phone number

Email (optional)

MEDOC® policy number

Up to 12 characters

What changes would you like to make?

Downgrade to Base Plan

Change Supplemental Trip Dates

none

Downgrade to Base Plan

We'll cancel all of your supplemental trips, and you won’t have coverage for any extended travel— beyond the number of days listed on your Base Plan policy.

Don’t worry, if you change your mind, you can always add supplemental trips at a later date.

I don't want to downgrade to the Base Plan

You can enter up to 3 trips

You can enter up to 3 trips
New departure date New return date

I don't want to change my supplemental trip dates

What changes would your insured spouse like to make?

Downgrade to Base Plan

Change Supplemental Trip Dates

none

Downgrade to Base Plan

We'll cancel all of your supplemental trips, and you won’t have coverage for any extended travel— beyond the number of days listed on your Base Plan policy.

Don’t worry, if you change your mind, you can always add supplemental trips at a later date.

I don't want to downgrade to the Base Plan

You can enter up to 3 trips

You can enter up to 3 trips
New departure date New return date

I don't want to change my supplemental trip dates

Spouse details

First name

Last name

MEDOC® policy number

Up to 12 characters

Same as member’s policy number

MEDOC® Supplemental Plan Change Form

Member Details

Downgrade to Base Plan

Downgrade to Base Plan

Spouse details

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