SAMU - Enrollment Form

Student Health & Wellness!mystudentplan is a benefits plan for students and can provide coverage for prescription drugs, vision care, dental care, mental health counseling, and more. The plan is designed to supplement provincial health insurance and provide additional access to medical services.

Online Forms

Are you covered by a comparable plan? Do you wish to cover your dependents? Or have you opted out of the plan and wish to be re-enrolled? Eligible Students may submit their online forms.

Health and Dental Re-Enroll Application

Deadline to re-enroll in the Student Benefits Plan

Fall term - September 30^th, 2024

After the deadline, the online form is only available for students who have lost their comparable coverage.

Re-Enroll Eligibility

There are 2 circumstances in which students who opted Out of the Student Health and Dental Plan may Re-Enroll: (1) when they are starting the fall term, or (2) when they are within 30 days of losing their alternate Health and Dental coverage.

Eligibility to Re-Enroll

How to Re-Enroll

To apply to Re-Enroll, you must be opted out of the Student Plan, meet the Re-Enroll eligibility criteria, are eligible for the Student Plan, and complete the online form before the applicable term deadline.

Steps to Re-Enroll

Student Health and Dental Fees:

These are the fees to re-enroll in the Student Benefits Plan. If an application is approved, the fees will be added to your student account.

Health	$114.75
Dental	$93.37
Health and Dental	$208.12

Things to consider:

All eligible students are automatically enrolled in the Student Health and Dental Plan and do not need to submit an opt-in form. You will see the Health Insurance Fee and the Dental Insurance Fee on your student account to confirm you are enrolled.
Students choosing to re-enroll in the Health, the dental or both plans.
Approval of the Student Benefits Plan re-enrollment application will result in the Health Insurance Fee and/or the Dental Insurance Fee being assessed on your student account.
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: macewanplan@mystudentplan.ca

The winter Re-Enroll deadline is closed.

The winter deadline to apply was January 31^st, 2024. The online Re-Enroll Form is not available at this time. The online form was open from December 1^st, 2023, until January 31^st, 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 term and missed the deadline, your next opportunity to apply should be the fall 2024 term.

The online form will be open for all eligible students in the fall term on August 1^st, 2024, and the deadline to apply is September 30^th, 2024.

The online form is only available for students who have lost their comparable coverage.

Eligibility Confirmation

Confirm your eligibility to re-enroll in the Student Benefits Plan by completing the following questions.

Have you ever Opted Out of the Student Health and Dental Plan?

Yes

No

Have you lost your comparable health and dental Coverage?

You may only apply within 30 days of the loss of your comparable coverage. After 30 days, your application will be denied.

Yes

No

You meet the eligibility criteria to re-enroll in the 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.

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

If your application is approved, the Health Insurance Fee and the Dental Insurance Fee will be added to your tuition, and you must provide the payment through myportal.macewan.ca before the applicable tuition deadline.

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

It appears you do not meet the criteria to re-enroll in the plan at this time.

Only students who previously opted out of the Health and Dental Plan may apply to re-enroll.

Eligible students are automatically enrolled in the Student Benefits Plan. There is no opt-in option for students attending non-eligible programs.

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 macewanplan@mystudentplan.ca or by phone at 780-497-4675.

It appears you do not meet the criteria to re-enroll in the plan at this time.

Only Students who previously opted out of the Student Plan and have lost their comparable coverage may re-enroll at any time of academic year within 30 days of the loss of coverage.

The next opportunity to submit your online opt-out application would be in the upcoming fall term.

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 macewanplan@mystudentplan.ca or by phone at 780-497-4675.

Health and Dental Re-Enroll Form

Complete all information on the re-enroll 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

F

M

U

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

Online Forms Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by January 31^st, 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.

SAMU Benefits Plan Office

Email: macewanplan@mystudentplan.ca
Phone: 780-497-4675
Address: 10850 - 104 Avenue NW
SAMU Building - SA-109A
Edmonton, AB. T5H 0S5

General Inquiries Line

Monday to Friday from 6:00am to 5:00pm MST

Phone: 1-877-746-5566 Ext. 7249

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