Opt In

You must only complete this form if you are in an eligible program and were not charged the fees or have opted out in the past.  

To enroll in the Student FLEXible Benefits Plan, 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 enrollment process to be completed. 

FLEXible Benefits
You have 4 Flex options available, if no option is selected you will be automatically enrolled in the Balanced Plan and cannot Flex your benefits until your next enrollment period. Should you choose to Flex your Benefits you will be enrolled in your chosen plan at any period in which you are enrolled in the Student Benefits Plan. Students choosing to Flex their Benefits must be enrolled in BOTH the health and dental plan.

Find out more information about your FLEXible options HERE.  

Please read and agree to the Terms & Conditions prior to submitting this form.