Funding & Forms

Medical Patient Transportation (MPT)

The MPT Program is available to on-reserve band members who need to travel to receive health care. Complete the application form here and bring it to the Splatsin Health Centre (by appointment only). Purchase orders will be completed on Tuesdays, Wednesdays and Thursdays from 9:00 a.m. to 12:00 p.m. Applicants will be notified when their purchase order is ready for pick up at a designated time. This program is administered by the First Nations Health Authority.

MPT Application Form Download

Injury Surveillance Form

If you have been injured, please complete this form and return it to Splatsin Health Services. You will be contacted by a health professional. This service is funded by the Secwepemc Health Caucus to collect data.

Injury Surveillance Form Download

FNHA Health Benefits

Splatsin does not directly provide health benefits for band members. First Nations Health Benefits (Health Benefits) covers specific health-related items and services to meet medical or dental needs not covered by third-party health insurance or the BC Medical Services Plan (MSP).

Learn about Health Benefits here

Submit receipts for reimbursement here

Call the First Nations Health Authority (FNHA) at 1-855-550-5454

Health & Wellness Funding 2020/21

Band members living on and off-reserve are eligible to receive up to $500.00 to cover medical expenses. Open the form to see eligible expenses and instructions. This application process is facilitated by Splatsin Administration and not Splatsin Health Services.

Eligible expenses include eye exams, prescription glasses, hearing aids, chiropractic, massage, physiotherapy, prescription drugs and dental. Applications are currently being accepted until March 31, 2020. Complete the fillable PDF/printable forms below or scroll down for the online form. All original receipts must be delivered by mail or in-person to Splatsin Administration, 5775 Old Vernon Rd., PO BOX 460, Enderby, B.C., V0E 1V0.

Youth Form Download

Adult Form Download

ADULT Health & Wellness Funding (Online Application Form) 2020/21

ELIGIBILITY: Applicants must be 19 or older and be a current, registered Splatsin band member. Receipts/invoices must be dated between April 1, 2020 and March 31, 2021. Up to $300.00 per applicant is available. Eligible expenses include eye care, hearing aids, chiropractic, massage, physiotherapy, prescription drugs and dental. HOW TO APPLY: 1. Complete this application form. Incomplete applications will not be processed. Please ensure your application is complete before submitting. 2. Mail-in or drop off the original receipts/invoices. 3. Wait up to 4 weeks to receive your cheque. Note: All cheques that are not reimbursements will be mailed to the service provider or organization.

Name (on Status card)*
First Last
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date*
Date Format: MM slash DD slash YYYY
Phone*
Email*
Birthdate*
Date Format: MM slash DD slash YYYY
Splatsin Status Number*
Recreation or Health Categories (check at least one)*
- Eyecare
- Prescription drugs
- Fitness fees
- Chiropractic, massage therapy, physiotherapy
- Dental
- Hearing aids, handicap parking permit
Applicants can claim up to $300.00. All expenses claimed must not be eligible under First Nations Health Benefits, Social Assistance, Employee Health Benefits, Veteran’s Benefits, or other resources available to the applicant.
Provide a description of expenses claimed.*
Total claim amount ($300.00 maximum)*
Please enter a number less than or equal to 300.00.
Mail or Deliver Receipts/Invoices
All claimed expenses must be accompanied by original receipts or invoices. Mail or deliver them to Splatsin Administration 5775 Old Vernon Rd., Enderby, BC, V0E 1V3. Receipts/invoices must be dated between April 1, 2020 and March 31, 2021.
Payable to (provide first and last name)*
First Last
Consent*
By checking this box, I confirm that the information provided in this application form is complete and accurate. I understand that my personal information will be shared internally with Splatsin's Administration Department.

YOUTH Health & Wellness Funding (Online Application Form) 2020/21

ELIGIBILITY: Applicants must be 19 or older and be a current, registered Splatsin band member. Receipts/invoices must be dated between April 1, 2020 and March 31, 2021. Up to $300.00 per applicant is available. Eligible expenses include eye care, hearing aids, chiropractic, massage, physiotherapy, prescription drugs and dental. HOW TO APPLY: 1. Complete this application form. Incomplete applications will not be processed. Please ensure your application is complete before submitting. 2. Mail-in or drop off original receipts or invoices. 3. Wait up to 4 weeks to receive your cheque. Note: All cheques that are not reimbursements will be mailed to the service provider or organization.

Name (on Status card)*
First Last
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Date*
Date Format: MM slash DD slash YYYY
Phone*
Email*
Birthdate*
Date Format: MM slash DD slash YYYY
Splatsin Status Number*
Parent/Guardian Name*
First Last
Recreation or Health Categories (check at least one)*
- Recreational fees (sports, arts, music, drama)
- Cultural or traditional activity fees (identified regional/provincial youth activities)
- Extra-curricular fees (sports teams or field trips)
- Health user fees (dental, eye care, physiotherapy, speech therapy, massage, chiropractic, prescription drugs and podiatric)
Applicants can claim up to $500.00. All expenses claimed must not be eligible under First Nations Health Benefits, Social Assistance, Employee Health Benefits, Veteran’s Benefits, or other resources available to the applicant.
Provide a description of expenses claimed.*
Total claim amount ($500.00 maximum)*
Please enter a number less than or equal to 500.00.
Mail or Deliver Receipts/Invoices
All claimed expenses must be accompanied by original receipts or invoices. Mail or deliver them to Splatsin Administration 5775 Old Vernon Rd., Enderby, BC, V0E 1V3. Receipts/invoices must be dated between April 1, 2020 and March 31, 2021.
Payable to (provide first and last name)*
First Last
Parent/Guardian Consent*
By checking this box, I confirm that the information provided in this application form is complete and accurate. I understand that my personal information will be shared internally with Splatsin's Administration Department.

Mail or Deliver Receipts/Invoices

Mail or Deliver Receipts/Invoices