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Family Add On Form

Family Add On

Coverage provided through the Student Health and Dental Plan can be extended to a spouse and/or dependent(s). To add eligible dependent(s) complete the sections below and submit this form. The Student will be contacted via email by the Benefit Plan Office of any required supporting documents and fees. All supporting document(s) and fees must be received by the applicable deadline in order for the family add on process to be completed. The Student must also be enrolled in the Student Health and Dental Plan.

Each year, you are given one opportunity to purchase family coverage for your spouse and/or dependent(s) and all family add-on forms and fees must be received within 30 days from the start of your program.

IMPORTANT! The fees for Family Add-on are in addition to the student health and dental fee. 

Spouse Eligibility

Spouse is defined as your spouse by marriage or under any other formal union recognized by law, or your common-law spouse. 

Common-Law Spouse is a person who has been living with you in a conjugal relationship continuously for a period of not less than one year or who is the natural or adoptive parent of a child of who you are also the parent.

Spouse means the person who is a resident of Canada, and who is married to the student or a person of either sex who have been continuously cohabitating with the student for a period of at least one year and who is publicly represented as the student’s wife or husband.

Dependent Children Eligibility

Children are defined as your natural children, stepchildren, legally adopted children, and children for whom you/and or your spouse have been appointed as guardian(s) for all purposed pursuant to an Order of the Court. NOTE: if the child is your stepchild or your spouse’s adopted child or a child for whom your spouse has been appointed guardian, both your spouse and the children must reside with you full-time. In addition, the child must be:
  • Unmarried
  • Under 21 years of age and not employed full-time
  • Under 25 years of age, if they are attending a college or university full-time, or
  • Physically or mentally incapable of self-support and became incapable to that extent while entirely dependent on the student for maintenance and support and while eligible under 1) or 2) above

NOTE: Parents, Grandparents, Siblings are not eligible dependents.

2022 - 2023 Family Add-On Fees:
Health (one or more dependent)            $150.00
Dental (one dependent)                        $200.00
Dental (two or more dependents)          $275.00

Please read and agree to the Terms & Conditions prior to submitting your online Family Add-On form.

Have a safe and healthy year!

Thank you

Lansdowne Campus
101B Fisher Building
3100 Foul Bay Road
Victoria, BC V8P 5J2
Phone: 250-370-3696
Fax: 250-370-3636

Interurban Campus
Campus Centre 111
4461 Interurban Road
Victoria, BC V9E 2C1
Phone: 250-370-3869
Fax: 250-370-3830

Student Information

Date of Birth
Phone Number
Program Start Date

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