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Family Add On

The family add on deadline for winter 2018 has passed, the next available period is Fall 2018.

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 SAMRU Student Benefit 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.

Please Note: January Family Add On fees are for 8 months of coverage, expiring August 31.  All plans are reset on September 1, and family add ons must be re-purchased before the applicable deadline.   

Full-time students that miss the Fall deadline are NOT eligible to add family members in the Winter semester but are eligible to add family members in the following Fall semester. The Winter semester family add on is only for brand new students starting in January.

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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