LCSA - Family Add-On Form

Group number: 330842
Certificate Number: Student ID
FAQ
Call Centre: 1-866-586-1010
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Student Health and Wellness! mystudentplan provides health, prescriptions, dental, mental health care plus additional benefits for eligible students.

Family Add-On Applications

Submit your health and/or dental family add-on application before the deadline.

Fall Application Period

July 1^st, 2024 to September 25^th, 2024

Make sure to submit your form by September 25^th as the online form will be accessible only to eligible students who have lifestyle changes.

Your student account fees only cover you. If you wish the same coverage for your dependents, you can purchase additional coverage using a credit card.

Family Add-On Eligibility

There are 3 circumstances in which students enrolled in the Student Health and Dental Plan may add dependents to their plan: (1) when they are new students, (2) when they are returning students on the anniversary of enrolling in the Student Benefits Plan, or (3) when they have a lifestyle change.

Family Add-On Eligibility

How to Add Family

To add dependents, you must be enrolled in the Student Benefits Plan, meet the Family Add-On eligibility criteria, and complete the online form before the applicable term deadline.

Steps to Add Dependents

Family Add-On Fees:

These are the fees to purchase family coverage, you must pay using a credit card (Visa® or MasterCard®) before the applicable payment deadline.

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Health	$160	Health	$200
Dental	$190	Dental	$270
Health and Dental	$350	Health and Dental	$470

These are the current family Add-on fees. However, the fees are subject to change without notice.
The Family Add-on fees are non-refundable and are not automatically renewed.
The Family add-on fees cover your dependents for 12 months. If you wish to keep your family covered, you must submit a new application before the applicable term deadline.
The family Add-On fees are not assessed as part of your term fees. If your application is approved, the Benefits Plan Office emails you a link, the payment deadline, and instructions to pay online using a credit card.

Things to consider:

You can only add as a dependent to your Student Benefits Plan your spouse or common-law partner and your children. Parents, grandparents, and siblings do not qualify as dependents.
Your dependents would be covered under your Student Benefits Plan, which means they would be entitled to the benefits you have through your plan.
Each dependent added uses the same plan card that the student has. The plan card must have the student's information (Full name and student ID).
Family Add-On fees are not automatically renewed every year. If students wish to keep the dependents covered, they must re-apply every 12 months (On the anniversary of adding dependents).
NO EXCEPTIONS will be made if the application or payment is missed. It is the student's responsibility to check their emails regarding the status of the application or deadlines.

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

Questions? Please contact your Benefit Plan Office: lethbridgeplan@mystudentplan.ca

The spring-summer Family Add-On deadline is closed.

The spring-summer deadline to apply was May 30^th, 2024. The online Family Add-On Form is not available at this time. The online form was open from April 1^st, 2024, until May 30^th, 2024.

NO EXCEPTIONS will be made if the deadline is missed.

If you were eligible for the plan for the first time in the winter or fall term and missed the deadline, your next opportunity to apply would be winter or spring-summer 2025 term respectively.

The online form will be open for new and returning students starting in the fall term on July 1^st, 2024, and the deadline to apply is September 25^th, 2024.

The online form is only available for students who have lifestyle changes.

Eligibility Confirmation

Confirm your eligibility to add your family to the Student Benefits Plan by completing the following questions.

Are you a new student who has been assessed the LCSA Health and Dental Plans fees on your student account?

You can only be assessed the Student Benefits Plan fees if you meet the plan eligibility criteria. Check the Student Benefits Plan Eligibility Criteria.

Yes

No

Are you a returning student on the anniversary of your enrollment in the Student Benefits Plan, who has been assessed the LCSA Health and Dental Plans fees on your student account?

The anniversary refers to when you first became eligible for the Student Benefits Plan and were assessed the fees. For instance, if you were first eligible for the Student Benefits Plan in the winter term, your anniversary would happen every winter term.

Yes

No

Are you a student enrolled in the Student Benefits Plan and have a lifestyle change such as getting married, common-law status, or birth/adopting a child?

You may only apply within 30 days of the lifestyle change. After 30 days, your application will be denied.

Yes

No

Are your family members eligible to be added to your Student Benefits Plan?

You can only extend your plan to your spouse or common-law partner and your children. Please check the eligible dependents.

Yes

No

You meet the eligibility criteria to add dependents to your plan at this time.

Complete the online form below to submit your application. Completing the questionnaire does not mean that your application is approved, the Student Benefits Plan Office will confirm your eligibility and process your application.

The Family Add-on fees are non-refundable and are not automatically renewed. Students must apply and purchase family coverage every year to keep them covered.

There is a 45-day validation period from the start of the program. 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.

Once you submit the Family add-on form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting a family add-on request.

It appears you do not meet the criteria to add dependents to your plan at this time.

Only students enrolled in the Student Benefits Plan and have lost their comparable coverage may apply to add dependents within 30 days of their lost.

Only new students or returning eligible students registered on the anniversary of enrollment in the Student Benefits Plan, attending an eligible credit program taking 6 or more credits, are automatically enrolled in the Student Benefits Plan and may apply to add their dependents.

If you have not been assessed the LCSA Health and Dental Plans fees on your student account, you are either not eligible for the Student Benefits Plan or currently have an active opt-out on file.

If you are a returning student enrolled in the Student Benefits Plan and the current term is not the anniversary of enrollment, the next opportunity to submit your online application would be on the anniversary of your enrollment in the Student Benefits Plan.

If you have any questions, please initiate a chat by clicking on the right-bottom corner icon or contact the Benefits Plan Office by email at lethbridgeplan@mystudentplan.ca or by phone at 403-320-3202 Extension 5310.

It appears you do not meet the criteria to add dependents to your plan at this time.

Only eligible dependents can be added to your Student Benefits Plan. Students can add the following dependents to their plan:

Spouse: By marriage or under any other formal union recognized by law or your common-law spouse of either sex who has cohabitated with the student minimum for one year.
Children: Your natural children, stepchildren, legally adopted children and children for whom you/and or your spouse have been appointed as guardian(s) for all purposes under an Order of the Court.
1. Unmarried
2. Under 21 years of age and not employed full-time
3. Under 25 years of age, if they are attending a college or university full-time, or
4. Physically or mentally incapable of self-support and became incapable to that extent while entirely dependent on the student for maintenance and support and while eligible under a) or c) above.

If you have any questions, please initiate a chat by clicking on the right-bottom corner icon or contact the Benefits Plan Office by email at lethbridgeplan@mystudentplan.ca or by phone at 403-320-3202 Extension 5310.

Health and Dental Family Add-On Form

Please complete all information on the family add-on 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

FMU

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

Fall Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by September 25^th, 2024

Plan Card Generator
Generate your Plan Card and use it where direct billing to Canada Life is available.

Prescription Search Tool
Find out if your prescription drugs are covered by the student plan.

Plan Claims
Learn more about submitting online or manual claims to Canada Life to get your refund.

Benefits Plan Office

Email: lethbridgeplan@mystudentplan.ca
Phone: 403 320-3202 Extension 5310
Address: Room CE1350, 3000 College Drive South.
Lethbridge, Alberta T1K 1L6, CA

General Inquiries Line

Monday to Friday
from 6:00am to 5:00pm MST
Phone: 1-866-586-1010

Family Add-On Applications

Fall Application Period

Family Add-On Eligibility

How to Add Family

Family Add-On Fees:

The spring-summer Family Add-On deadline is closed.

Eligibility Confirmation

Are you a new student who has been assessed the LCSA Health and Dental Plans fees on your student account?

Are you a returning student on the anniversary of your enrollment in the Student Benefits Plan, who has been assessed the LCSA Health and Dental Plans fees on your student account?

Are you a student enrolled in the Student Benefits Plan and have a lifestyle change such as getting married, common-law status, or birth/adopting a child?

Are your family members eligible to be added to your Student Benefits Plan?

Health and Dental Family Add-On Form

Student Information

Benefits Plan Office

General Inquiries Line

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