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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 re-enrolled? Eligible Students may submit their online forms.

Health and Dental Re-Enroll Application

Only submit this form if you have previously opted out of the health and dental plan and wish to re-enroll. All new or returning eligible students are automatically enrolled in the benefit plan.

Eligibility Criteria

There are 2 circumstances for re-enrolling in the Student Health and Dental Plan:

1 Anniversary of Opting Out of the Plan

Eligible students who previously opted out of the benefits and are attending the school on the anniversary of opting out of the plan and meet the eligibility criteria to be enrolled in the student plan may apply to re-enroll in the plan by the applicable term deadline.

Example: If your opt-out application was approved during the fall term, you only may re-enroll in the plan in the fall as your anniversary of opting out is every fall term.

2 Loss of Comparable Coverage

Eligible students who previously opted out of the benefits and have lost their comparable insurance coverage may re-enroll within 30 days of losing that coverage.

Proof of losing coverage must be sent to
after completing this form.

Documentation includes a letter from the insurance carrier or the employer stating the student's name, loss of coverage date, the insurance carrier's name & policy number.

Deadline to Submit Applications

Eligible students must submit their applications before the applicable term deadline. NO EXCEPTIONS will be made if the deadline is missed. Before submitting an application make sure that you meet the eligibility criteria above.

Winter 2023
February 8th, 2023

Spring/Summer 2023
June 6th, 2023

Fall 2023
October 4th, 2023

If you do not meet the eligibility criteria to be automatically enrolled in the student plan, please do not complete this form. There is no opt-in to the student plan.

Important Notes:
  • All eligible students are automatically enrolled in the Student Health and Dental Plan and do not need to submit an re-enroll form. You will see a health fee and dental fee on your student account to confirm you are enrolled.
  • The effective date of your coverage is the 1st day of the month when your term begins.
  • There is a 45-60-day validation period from the start of the term. 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 benefits card will be automatically activated.
  • NO EXCEPTIONS will be made if the deadline is missed.
  • Once you complete the re-enroll form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting an re-enroll request.

Steps to Submitting a Re-enroll Application:

1Student Information
Complete this section below providing true and correct information. Click NEXT.
2Enrolment Circumstances
Scroll down and check Health Plan/Dental Plan/Qualify. You can choose Health or Dental or both plans. Select your status and Click NEXT.
3Read 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.
4Confirmation 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.
5Application status
You will receive an email with the status of your application.
6Pay the fees
If your application is approved, the fees will be included in the student account.

Add to your address book. Please do not reply to this email.

Questions? Please contact your Benefit Plan Office:

Health and Dental Re-Enroll Form

Student Information

Date of Birth
Phone Number
Program Start Date