Upon receipt of your request, a HIF representative will contact you to discuss your available options.
If you hold a Low Income Health Care Card, please enter the number below:
If you do not hold a Low Income Health Care Card, please select from the following categories below:
Please select all that apply.
Please provide as much information as possible.
Please enter the suspension period that you wish to apply for:
(minimum period 3 months, maximum period 6 months)
In order to submit this request, you must read and agree to the following Terms & Conditions for Financial Hardship.
View HIF's Terms & Conditions
Please note: All Financial Hardship requests require review from our Member Action Review Committee before approval can be granted.