Upon receipt of your request, a HIF representative will contact you to discuss your available options.

Your details:

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)

Important Information

In order to submit this request, you must read and agree to the following Terms & Conditions for Financial Hardship.

View HIF's Terms & Conditions

Data Collection

By clicking "Submit" I consent to the collection of my data in accordance with HIF’s Privacy Policy.

Please note: All Financial Hardship requests require review from our Member Action Review Committee before approval can be granted.