Forms | Gallivan

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

Important Notice!

Students must submit the applicable online form for each of the following services that they are choosing to waive:

Failure to submit any or all the opt-out forms within the applicable deadline will result in you remaining enrolled in said service and being charged the associated fee on your student account.

Students are required to provide proof of alternative, comparable coverage for the Health & Dental Plan and the International Emergency Health Insurance.

Deadline to submit applications

Online Application Forms

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

Opt-Out Application

If you are covered by a comparable Health and Dental Plan from parents, spouse, work, government, or through your band and you do not wish to coordinate benefits, you must submit an online Opt-Out application.

Opt-Out form

Family Add-On Application

Extend your plan to your dependents and provide them with the same protection you have. Additional charges can be paid using a credit card.

Family Add On Form

Re-Enroll and Opt-In Application

Complete this application if you previously opted-out and need to re-enroll in the plans, or if you qualify to opt-in based on your status as a student.

Re-enroll and Opt-In Form

Enrolment Options
Add Family, Opt-in, and Opt-out
Deadline: 30 days from the start date of your program

International Opt Out
Opt out with your MSI Card today.

Health & Dental myBenefits Card Generator
Generate your benefit Card today.

Prescription Search
Base on National Formulary Prescription.