The Plan Card is an important piece of identification that will ease access to your benefits. All eligible students must complete the Plan 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 Plan Card you must first register for BC Fair Pharmacare. Once your registration is completed simply complete the Plan Card Registration Form.
Please note: 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.
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 KSA Student Benefit Plan 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.