RRCSA - Family Add-On Form

Student Health & Wellness!mystudentplan is a benefits plan for students and can provide coverage for prescription drugs, vision care, dental care, mental health counseling, and more. The plan is designed to supplement provincial health insurance and provide additional access to medical services.

Online Forms

Are you covered by a comparable plan? Do you wish to cover your dependents? Or have you opted out of the plan and wish to be re-enrolled? Eligible Students may submit their online forms.

Health and Dental Family Add-On Application

Deadline to submit applications
30 days from the official start date of your program.

Only new students or returning students whose anniversary of enrollment is the current month who are active in the Student Plan may apply to extend their benefits to their dependents before the deadline.

The fees on the student account are for the student only. Students must pay additional fees to have their family members added to the plan.

Eligibility Criteria

There are 2 circumstances for adding family members to the Student Health and Dental Plan:

1 Academic Enrollment

Students who are eligible for the plan and wish to extend their benefits to their dependents may apply according to the university enrollment:

New Students: starting an eligible program and qualifying for the plan who wish to extend their plan to their dependents may apply by the applicable deadline.
Returning Students: Returning Students enrolled in the plan and on their anniversary of starting an eligible program who wish to extend their plan to their dependents may apply by the applicable deadline.

The deadline is 30 days from the official start date of your program.

2 Lifestyle Change

Students enrolled in the plan who have a lifestyle change such as getting married, meeting the twelve-month co-habitation requirement for common law status, or birth/adopting a child, who wish to extend their plan to their dependents may apply within 30 days of lifestyle change.

To apply, please email proof of Lifestyle Change to the Benefit Plan Office at redriverplan@mystudentplan.ca after completing this form.

Documentation includes a marriage certificate, birth certificate, or adoption documents.

The deadline is within 30 days of the lifestyle change.

Deadline example for new & returning students:

If your program starts on August 28^th, you may submit an online application before September 27^th. If you miss the deadline, your next opportunity to opt-out would be next August.

Health and Dental Plan Family Add-On Fees:

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Health	$135.00	Health	$135.00
Dental	$160.00	Dental	$290.00
Health & Dental	$295.00	Health & Dental	$425.00

International Emergency Health Insurance Plan Family Add-On Fees:

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Emergency Health Insurance	$800.00	Emergency Health Insurance	$1,250.00

Health and Dental Plan and International Emergency Health Insurance Plan Family Add-On Fees:

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Health	$135.00	Health	$135.00
Dental	$160.00	Dental	$290.00
Emergency Health Insurance	$800.00	Emergency Health Insurance	$1,250.00
Emergency Health Insurance and Health	$935.00	Emergency Health Insurance and Health	$1,385.00
Emergency Health Insurance and Dental	$960.00	Emergency Health Insurance and Dental	$1,540.00
Emergency Health Insurance and Health & Dental	$1,095.00	Emergency Health Insurance and Health & Dental	$1,675.00

These are the current International Emergency Health Insurance Plan Family Add-on fees. However, the fees are subject to change without notice.
These fees are not included in your tuition, and you will pay them with a credit card on our website if your application is approved.
The Family Add-on fees cover 12 months of coverage.
Health and Dental Plan or International Emergency Health Insurance Plan Family Add-On Fees are non-refundable.

Important notes:

If you started your program in a different month than the current one, your request to add family will not be approved at this time. Your next opportunity to extend your plan would be the next anniversary of the start date of your program.
International students are required to purchase the International student emergency plan coverage for their dependents in order to purchase extended health benefits for their dependents.
You can only extend your plan to your spouse or partner and your children. Parents, Grandparents, and Siblings are not eligible dependents to extend your plan. Please check the eligible dependents.
If you are applying because of a lifestyle change, you must provide the proper documentation and complete the online form. Otherwise, your application will be denied.
The family would be covered by the same plan the student has. The student and the family member do not share the coverage.
The family fees provide coverage for one year. The student needs to keep active in the plan for 12 months. If the student loses the coverage, the family loses the coverage too. The effective date of your coverage would be the 1^st day of the month when your program begins.
Family Add On requests & fees are not automatically renewed and must be submitted/paid every year.
There is a 45-day validation period from the start of the program. During this time, you would have to pay out of pocket for all eligible Health and Dental expenses and keep the receipts. After the enrollment process is complete, you will be able to submit online claims for reimbursement and your Plan Card will be automatically activated.
Each family member uses the same card that the student has. The card must have the student's information (Full name and student ID).
The fees for Family Add-on are non-refundable.
NO EXCEPTIONS will be made if the application or payment is missed. It is the student's responsibility to check their emails regarding the status of the application or deadlines.
Once you complete the Family add-on form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting a family add-on request.

Steps to submitting a Family Add-On Application:

1 Student Information

Complete this section below providing true and correct information. Click NEXT.

2 Dependent Information

Scroll down and check Spouse/Child/Children according to the members you wish to add. Provide full name, initials, gender, and date of birth for each member. Click NEXT.

3 Read and Agree to the Terms and Conditions

Click on the checkbox to indicate that you agree to the Terms and Conditions agreement. Click SUBMIT to finish your application.

4 Confirmation email

Check your email and verify if you have received the confirmation email. If you do not receive this email, you must resubmit the form.

5 Application status

You will receive an email with the status of your application.

6 Pay fees online

If your application is approved, you will receive a link to pay the applicable fees with your credit card and the deadline to pay them.

Add donotreply@gallivan.ca to your address book. Please do not reply to this email.

Questions? Please contact your Benefit Plan Office: redriverplan@mystudentplan.ca

Health and Dental Family Add-On Form

Please complete all information on the family add-on form and we will process your application as soon as we can.

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

Sex

F

M

U

Date of Birth

Date Month Field Date Day Field Date Year Field

Phone Number

Phone Area Number Phone Local Number Phone Digits

Program Name

Program Start Date

Date Month Field Date Day Field Date Year Field

Online Forms Deadline
Add Family, Opt-in or Opt-out
Submit your applications within 30 days from the official start date of your program

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Notre Dame Campus

Phone: 204-632-2503
Address: RRCSA Student Benefits Plan Office
Room CM75C
2055 Notre Dame Avenue
Winnipeg, Manitoba. R3H 0J9

Exchange District Campus

Phone: 204-949-8537
Address: The Roblin Centre
SA Office P-110
160 Princess Street
Winnipeg, Manitoba. R3B 1K9

Email: redriverplan@mystudentplan.ca

General Inquiries Line

Monday to Friday from 5:00am to 4:00pm PST

Phone: 1-877-746-5566 Ext. 7249

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