Divorce or separation
To report a divorce or separation, follow these three steps:
1.
Gather the required documents
You will need to provide additional documents along with the completed form.
You must submit a copy of one of the following documents:
A document issued by a provincial/territorial court (or other jurisdiction) which confirms that a divorce has been finalized and that the parties named are free to re-marry. It is used as proof of a family separation, and also as proof that a person may legally re-assume a maiden surname if they were previously using their spouse’s surname during the marriage.
This is a brief self-declared letter/note that indicates that due to a family separation the two spouses from the family Manitoba Health card should be separated. It should contain names and date of birth of both spouses, Personal Health Identification numbers, the date of separation/divorce, and if possible, updated mailing addresses of both spouses.
This is a legal document that is an agreed-upon plan for a family separation. It is used to determine custody of minor children as they can only appear on one Manitoba Health registration card at a time. The entire document must be submitted for review.
This is a document issued by a provincial/territorial court (or other jurisdiction) that restricts access of one individual or party to another individual or party. For Manitoba Health purposes it is used to move spouses or minor children from, or to, different Manitoba Health registration cards.
2.
Complete the form
The form can only be filled out by the cardholder.
You will need your Health Card Registration Number and Personal Health Identification Number (PHIN).
You can see where these numbers are located on your Manitoba Health Card here.
If you do not have your health card information available, please contact 204-786-7101 or 1-800-392-1207 (toll free).
When you are ready, complete the following form:
Divorce or Separation Form - Manitoba Health (PDF)3.
Submit
To submit your request, send the completed form and copies of the required documents to one of the following:
Email:
insuredben@gov.mb.ca
OR
Mail:
Registration and Client Services Unit
Manitoba Health
300 Carlton Street
Winnipeg, Manitoba R3B 3M9
OR
In Person Drop Off available at 300 Carlton Street
Business hours: Monday to Friday, 8:30am to 4:30pm
Need help?
Public Access Computers are available at the following locations:
Winnipeg
Registration and Client Services
Manitoba Health
300 Carlton Street
Winnipeg, Manitoba R3B 3M9
Business hours: Monday to Friday 8:30 to 4:30
Bilingual Service Centre
Main floor, 170 Goulet St, Winnipeg MB
Rural areas
Contact the city or municipal office in your area, or visit the Bilingual Service Centre nearest you:
51 Rogers St, Notre-Dame-de-Lourdes MB
Unit A, 30 Dawson Rd, Ste Anne MB
Recreational Centre on Hwy 6, St. Laurent MB
427 Sabourin St, St-Pierre-Jolys MB