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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 re-enrolled? Eligible Students may submit their online forms.

Submitting Online Applications

Before submitting your online forms, please review the eligibility criteria and read the Terms and Conditions.

The online forms for Fall have closed

Calendar The Fall deadline was September 30th, 2022

The following online forms are not available at this time:

  • Health & Dental Opt-Out
  • Health & Dental Family Add-on

Winter 2023 forms available in December. Deadline to submit for winter eligible students is January 27th, 2023. If you were eligible for the plan for the first time in the Fall term and missed the deadline, your application will be denied.

Opt-Out Application

If you are covered by a comparable Health and Dental Plan from parents, spouse, work, government, or band and do not wish to Coordinate Benefits, you may submit an online Opt-Out application.
Opt-Out form

Direct Deposit

If you have previously opted out of the student benefits plan and would like to update your direct deposit information, you may submit an online application to change your banking information to get the opt-out reimbursement.
Direct Deposit Form

Family Add-On Application

Extend your plan to your dependents and provide the same protection you have. Additional charges that must be paid using a credit card.
Family Add On Form

Re-enroll Application

If you previously opted out of the plan and have lost your comparable coverage or a lifestyle change occurred, you may re-enroll into the Student Plan.
Re-enroll Form
Deadline

Winter Deadline to submit applications