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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 or due to a previous waiver on file. To enroll in the Student Health and/or Dental plan(s), complete the 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 in order for the enrolment process to be completed.

If a student has successfully completed an opt out but requires re-enrolment into the plan there are 2 opportunities to do so:

1) Upon Policy Anniversary: For students starting in September, the anniversary would be the following September prior to the applicable deadline. For students starting in January the anniversary would be the following January prior to the applicable deadline.

2) 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.

3) Loss of Alternate Coverage: Students who lose their comparable coverage may opt back into the plan(s), provided that they are 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.

Accessibility Students
The Student Benefits Plan fee is assessed annually, except when a student’s enrolment status excludes them from automatic inclusion by the institution. 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 receive the same coverage as full-time students. Please fill out the Opt-in form. Indicate you are a student with a disability and ask your Accessibility Advisor to confirm with me by email at georgianplan@mystudentplan.ca. Once I get confirmation, the fee will be assessed to your Banner account. 

You are only required to submit this form if you have previously opted out of the health and/or dental plan and wish to re-enrol, or you qualify based on an approved exception from the Georgian College SA Benefits Plan Office. 

Please read and agree to the Terms & Conditions prior to submitting your online enrolment form.

Student Information

Gender
Date of Birth
Phone Number
Program Start Date

Please enter the date you lost the coverage


           
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