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Family Add On

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. You will then be contacted by the Student Benefits Plan Office, 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. IMPORTANT: These fees are in addition to the student health and dental fee. 


Fall 2018 Family Fees (12 Month Fee):
Health and Dental (one or more dependent)  $489.07
Health only (one or more dependent) $243.74
Dental only (one or more dependent) $245.33

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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