DSU - Enrollment 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 Re-Enroll or Opt-In Application

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

All new or returning eligible students having 6 or more credits at Douglas College are automatically enrolled in the benefits plan.

Eligibility Criteria

There are 2 circumstances for re-enrolling and 1 circumstance for opting into the Student Health and Dental Plan:

1 Fall Semester

Students who previously opted out of the benefits and are attending the school in the fall semester and meet the eligibility criteria to be enrolled in the student plan may apply to re-enroll in the plan by the applicable fall deadline.

Fall 2023 deadline is Friday, September 29^th, 2023, at 4:00 pm

2 Loss of Comparable Coverage

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
info@thedsu.ca
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.

The deadline is within 30 days of losing coverage.

3 non-automatically-eligible students

Part Time Students: Students attending the College in the Fall semester and enrolled in a minimum of 3 credits but fewer than 6 credits may opt-in to the Plan by the applicable semester deadline.

January Start Students: Students attending the College for the first time in the Winter semester and enrolled in a minimum of 3 credits may opt-in to the Plan regardless of the number of credits by the applicable winter deadline

Winter deadline is January 31^st, 2024, at 4:00 pm

Re-enroll or Opt-In Fees:

SEMESTER	HEALTH AND DENTAL PLAN FEE
Fall	$425.00
Winter	$375.00

These are the current re-erroll or opt-in fee. However, the fees are subject to change without notice.
The re-erroll or opt-in cover 12 months of coverage for the fall semester applications and 8 months of coverage for the winter semester applications.

Important notes:

Eligible students having 6 or more credits at Douglas College are automatically enrolled in the Student Health and Dental Plan and do not need to submit an opt-in form. There will be a health fee and dental fee on your student account to confirm you are enrolled.
The effective date of your coverage is the 1^st day of the month when your semester begins.
There is a 45-60-day validation period from the start of the semester. 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.
NO EXCEPTIONS will be made if the deadline is missed.
Once you complete the Re-Enroll or Opt-In form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting a Re-Enroll or Opt-In request.

Steps to Submitting a Re-Enroll or Opt-In Application:

1Student Information

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

2Enrollment 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 because of the program start date or eligible exclusions, the fees will be included in the student account. Otherwise, you will receive a link to pay the applicable fees with your credit card by the applicable deadline.

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

Questions? Please contact your Benefit Plan Office: info@thedsu.ca

Health and Dental Re-Enroll or Opt-In Form

Please complete all information on the re-enroll 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

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

Winter Deadline
Submit your Family Add-On, Opt-in applications by January-31^st, 2024 at 4 pm

Plan Card Registration Form
Register for your Plan Card and use it where direct billing to Green Shield Canada is available.

Your Benefits
Find out what your plan covers

On Campus Care
Need extra help?
Visit us at our office!

New Westminster Office

Email: info.nwcampus@thedsu.ca
Phone: 604-527-5110
Address: 88 Seventh Street, 2nd Floor
New Westminster, BC

David Lam Campus Office

Email: info.coqcampus@thedsu.ca
Phone: 604-777-6257
Address: 1250 Pinetree Way, DSU Kiosk (next to Security)
Coquitlam, BC. V3B 7X3

General Inquiries Line

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

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

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