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The deadline for Opt In or Family Add On form has passed for the Winter 2019 and starts. Please stay tuned for the Fall 2019 Opt In or Family Add On form.

The September opt-out deadline is January 31, 2019 at midnight.

Only students with existing, equivalent extended health and dental plans are eligible to opt out of the Douglas Students’ Union Health and Dental Plan. You must have proof of alternate coverage.

PLEASE NOTE: that the BC Medical Services Plan (MSP) is not an extended health and dental plan and therefore does not qualify as equivalent coverage.


Log in to your Douglas College online account
  > Select “Registration”
  > Select “Medical/Dental opt-out”
  > Click “Continue”
  > Select your benefits carrier and enter your plan number

This will trigger a credit to your account once your benefits carrier has been verified.

The opt-out process must be completed each year that you are assessed the Health and Dental Plan fee.


For new students on the plan the electronic myBenefits card will not be available until October 16th. For more info or to obtain a paper card please visit one of the DSU offices.

The myBenefits Card is an important piece of identification that will ease access to your benefits. All eligible students must complete the myBenefits Card Registration Form. This multi-purpose card provides your policy information for submission of claims at both the Pharmacy and the Dental Office.

To obtain your myBenefits Card you must first register for BC Fair Pharmacare. Once your registration is completed and you have received your registration number you must complete the myBenefits Card Registration Form.

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Please note, your BC CareCard number is NOT your BC Fair Pharmacare registration number. Please use the link provided to complete this step BEFORE submitting your application.

 

 Non BC Residents: if you are not a permanent resident of BC you must still fill out the registration form providing your home province or country in place of the Fair Pharmacare registration number.

If you would like to pick up your myBenefits Card directly from the DSU Office please download and complete the Benefits Card Registration Form and take it with you to the office

Downloading the myBenefits Card does not confirm eligibility or benefits coverage. please contact The DSU Office to confirm your enrolment in the plan.



Student Information

Gender
Date of Birth
Phone Number
Program Start Date
 
  • British Columbian Students - Please list your BC Fair PharmaCare Number
  • Out of Province Students - Please list your home province
  • International Students - Please list your country of residence
Please indicate how you would like to access your benefits card

Enrolment in the Student Health and Dental plan not guaranteed by submitting this form; The Student must be eligible for the program.

Should you have any questions regarding the enrolment process please contact The DSU Office prior to submitting this form.

I understand the information provided above is required in order to obtain the said pay direct drug card. I hereby authorize and consent to the use, release, and exchange of the above information between the institution, the student organization, the Student Service Co-ordinator, Gallivan & Associates, BCE Emergis Assure Health Division, and the insurance carrier(s) to be used solely in connection with the Student Benefits Plan. I confirm that all the information provided herein is accurate. I also understand that the Student Service Coordinator may need to notify the institution to find out whether or not I have paid for the plan.

Opt In


Nine Credits or More (Mandatory)
All students enrolled in nine credits or more in the Fall semester are automatically enrolled in the plan.

Fewer than Nine Credits and minimum of 3 credits (Optional Opt-in)
Part-time students enrolled in a minimum of 3 credits but fewer than nine credits in the Fall Semester may enroll in the plan, provided they complete the enrollment process and pay the required $425 premium prior to the applicable deadline.
It is the student's responsibility to complete the Individual Enrollment form and provide payment of the applicable fee(s) prior to the deadline.

New Winter Semester Students (Optional Opt-in)
All students attending the College for the first time in the Winter Semester and enrolled in a minimum of 3 credits, may elect to enroll in the plan, regardless of number of credits, provided they complete the enrollment process and pay the required $375 premium prior to the applicable deadline.   
For these members, the benefit period begins January 1 and ends August 31 of the same year.

IMPORTANT DEADLINE INFORMATION:
The deadline for Fall part-time student enrolment in the plan is 4:00pm the last business day of September.
The deadline for new Winter student enrolment in the plan is 4:00pm the last business day of January.
ENROLLMENT FEES ARE NON-REFUNDABLE

IF YOU HAVE BEEN CHARGED FOR THE HEALTH AND DENTAL PLAN IN YOUR TUITION YOU DO NOT NEED TO COMPLETE THIS FORM!

Student Benefits Plan coverage is provided to eligible students automatically, except in certain circumstances where a student's enrollment status excludes them from automatic inclusion by the institution or due to a previous opt-out on file. To enrol in the Student Health & Dental plan, complete the sections below and submit this form. You will then be contacted by Gallivan & Associates, via an email notification, of any required supporting documents and fees. All supporting document(s) and fees must be received by the applicable deadline in order for the enrolment process to be completed.

Please read and agree to the Terms & Conditions prior to submitting your online Enrollment Form.

Student Information

Gender
Date of Birth
Phone Number
Program Start Date

Family Add On


Adding Optional Family Coverage
Each year, students are given one opportunity to purchase family coverage for their spouse and/or dependent(s) by completing an application form and paying the family coverage fee. Family coverage is then added during the enrolment processing period.
Family coverage must be re-purchased each year and is the student's responsibility to do so by the applicable deadline for their enrolment period. A student's family can only be covered while they are a student on the plan.
For information about eligible family members please refer to the "Family Covered" tab.

Spouse or Child (+1) (Optional Opt-in)
Students with a dependent (i.e. spouses or child) may opt-in that individual by paying an additional $425 ($375 in the case of new Winter Semester students).

Family Coverage (2+) (Optional Opt-in)

Students with families (i.e. more than one additional individual) may opt-in their family members by paying an additional $675 ($595 in the case of new Winter Semester students).

IMPORTANT DEADLINE INFORMATION:
The Fall deadline for adding dependents to the plan is 4:00pm on the last business day of September.
The Winter deadline for adding dependent to the plan is 4:00pm the last business day of January.

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. You will then be contacted by Gallivan & Associates, via an email notification, 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.

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

Student Information

Gender
Date of Birth
Phone Number
Program Start Date

Service Members


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