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University Health Insurance Plan (UHIP)

1. Have your UHIP Member ID and Policy # available so the MD Connected patient care team can verify your coverage eligibility.
2. Please complete the UHIP claim authorization form provided below and email it to admin@mdconnected.ca.
UHIP Claim Authorization Form (52kb)

Guard.Me International Insurance

1. Have your Guard.Me policy card ready so the MD Connected patient care team can verify your coverage eligibility.
2. Please complete the MD Connected authorization form provided below and email it to admin@mdconnected.ca.
MD Connected Authorization Form (49kb)

MSH International (Intrepid 24/7)

1. When using this service, you or your guardian can call Intrepid 24/7 prior to seeking an appointment, and their customer care team will direct you to a contracted clinic.
2. Intrepid 24/7 will fax over the pre-authorization forms. If the forms have not been received by MD Connected you must call the insurer to fax the Verification of Benefits to us.
3. You or your guardian must present your Intrepid 24/7 policy card upon arrival so that our patient care team can verify that you have eligible coverage and sign the authorization forms.

Blue Cross (IFH Refugee)

1. You must provide one of the below forms. As long as you have coverage, which can be validated by an MD Connected customer care team member, your visit can proceed.
a. A refugee protection claimant document (RPCD) with photo.
b. An interim federal health program certificate (IFHC).

Fee schedule

Due to the COVID-19 pandemic, patients that are in Ontario who are uninsured are currently not charged for General Practitioner visits.

General Practitioner Visit

Type of Visit	Fee
General Visit – Virtual	$45.00
Mental Health Treatment/Management	$90.00
Travel Consultation	$70.00
Travel Consultation - 2 people	$100.00
Travel Consultation - Group (Up to 4 people)	$140.00

Specialist Visit

Specialty Type	Initial Consultation	Follow Up Appointment
Internal Medicine	$170.00	$110.00
Urology	$100.00	$65.00
Pediatrics	$100.00	$75.00
Missed Specialist Appointments	$50.00

Medical Forms & Notes

Form Type	Fee
School or Work note (per note)	$20.00
Note for insurance coverage (Massage Therapy, Orthotics, etc.)	$20.00
Travel cancellation form	$40.00
Completion of forms (ex. University forms)	$50.00
Non-WSIB FAF form	$70.00
Attending Physician's Statement (Including disability forms)	$120.00
Photocopy per page	$1.00

In Office Procedures

Procedure Type	Fee
Urine pregnancy test	$10.00
Injection for travel purposes (or non-OHIP injections)	$15.00
Ear flush	$25.00