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Enrollment Form

Opt-In


Student Benefits Plan coverage is provided to eligible students automatically, except in certain circumstances where a student’s enrolment status excludes them from automatic inclusion by the institution (see Accessibility Students below) or due to a previous waiver on file.
You may submit an OPT-IN form if you have previously opted out of the health and/or dental plan and wish to re-enroll, you have experienced a lifestyle change, or you qualify based on an approved exception from the Georgian College SA Benefits Plan Office.

For more details, see below.


Did you previously complete an Opt-out and want back on the plan?

Upon Policy Anniversary: Georgian’s policy year is from September 1 to August 31. As a student, the policy anniversary is determined by the first semester of your academic year.

For example, if you are attending classes in Fall – that is your opportunity, and you must submit the form before the Fall deadline. If you begin your year during the winter semester – you must submit the form before the winter deadline. If you first start during the summer – you must submit the form before the summer deadline.  

Loss of Alternate Coverage: Students who lose their comparable coverage may opt back in to the plan(s), provided we are advised within 30 days of losing coverage. If a student has lost their comparable coverage, they must show documentation of loss by submitting a letter from either the insurance carrier or employer. A pro-rated fee will be charged for the health plan based on the month the policy is reinstated and the number of remaining months of the benefit year. The dental premium does not change during the benefit year.

Have you have experienced a lifestyle change?

Lifestyle Change: There are certain circumstances known as lifestyle changes that allow a student to make changes to their enrolment status within 30 days of the change. Lifestyle changes include getting married or meeting the twelve-month co-habitation requirement for common law status, birth/adoption of a child, meeting provincial plan residency requirements, and losing their alternate coverage (see above).
A pro-rated fee will be charged for the health plan based on the month the policy is reinstated and the number of remaining months of the benefit year. The dental premium does not change during the benefit year.

Are you a student registered with Accessibility Services?

If you are a student taking a reduced course load due to a documented disability with Student Accessibility Services, you are eligible to opt-in to the Student Benefits Plan. You are considered Full-time Equivalent and can request to be enrolled on the student insurance plan. **Please note: If you are taking a full-time course load, you will automatically be charged the fee and enrolled on the plan. You do not need to fill in the form.

The Student Benefits Plan fee MUST be assessed during the first semester of your academic year. EACH YEAR, you are required to complete the opt-in form during the applicable window of your FIRST academic semester. No exceptions can be made.

For example, if you are attending classes in Fall – that is your opportunity to enroll, and you must submit the form before the Fall deadline. If you begin your year during the winter semester – you must submit the form before the winter deadline. If you first start during the summer – you must submit the form before the summer deadline.
 
When completing the opt-in form, indicate you are a student with a disability. Ask your Accessibility Advisor to confirm you qualify by emailing georgianplan@mystudentplan.ca. Once confirmation is received, the fee will be assessed to your Banner account, and you will be notified about how to make the payment. 

If you have any questions on Opting in to the insurance plan, please email georgianplan@mystudentplan.ca.

To enroll in the Student Health and/or Dental plan(s), complete the fillable sections below and submit this form. You will then be contacted by the Georgian College SA Benefits Plan Office, via an email notification, of any required supporting documents and/or fees. All supporting document(s) and/or fees must be received by the applicable deadline for the enrolment process to be completed.

Student Information

Gender
Date of Birth
Phone Number
Program Start Date

Please enter the date you lost the coverage


           
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