Re-Enrollment Form

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.

Health and Dental Re-Enrollment

All eligible students are automatically enrolled in the Student Health and Dental plan, so they do not need to apply for coverage.

Eligibility Criteria

There are 3 scenarios for enrolling in the Student Health and Dental Plan:

1 eCampus and ALP-AU students

Full-time eCampus and ALP-AU students are eligible to opt into the plan within the applicable deadlines.

Deadline to submit application
Students starting in September can submit the opt-in form by October 3^rd. All other students starting outside September have 30 days from their program start date.

2 Loss of Comparable Coverage

Students who previously opted out of the benefits may re-enroll in the plan within that benefit year if they have lost their comparable insurance coverage. You must provide the proper documentation and complete the online form. Documentation includes a letter from the insurance carrier or the employer stating the students' name, loss of coverage date, the carrier's name, and policy number. This documentation must be emailed to nsccplan@mystudentplan.ca

Deadline to submit application
Within 30 days of losing that coverage

3 Lifestyle Change

Students who previously opted out of the benefits within that benefit year may re-enroll in the plan if they have a lifestyle change. There are certain circumstances known as lifestyle changes such as getting married, meeting the twelve-month co-habitation requirement for common law status, birth/adoption of a child, and meeting provincial plan residency requirements that allow students to apply. You must provide the proper documentation and complete the online form. Documentation includes a marriage certificate, birth certificate or adoption documents. This documentation must be emailed to nsccplan@mystudentplan.ca

Deadline to submit application
Within 30 days of the change date

Important notes:

Eligible students are automatically enrolled in the Student Health and Dental Plan and do not need to submit an opt-in form. There will be a health fee and dental fee on your student account to confirm you are enrolled.
The student individual enrollment is NOT automatically renewed. In order for the student opt-in to continue, the student must purchase the coverage each benefit year before the applicable deadline.
The effective date of your coverage is the 1^st day of the month when your program begins.
There is a 45-60-day validation period from the start of the program. 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 benefits card will be automatically activated.
NO EXCEPTIONS will be made if the deadline is missed.
Once you complete the Opt-In form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting an Opt-In request.

Steps to submitting your Opt-In:

1Student Information

Complete this section below providing true and correct information. Click NEXT.

2Enrollment Circumstances

Scroll down and check Health Plan/Dental Plan/Qualify. You can choose Health or Dental or both plans. Select your status and Click NEXT.

3Read and Agree to the Terms and Conditions

Click on the checkbox to indicate that you agree to the Terms and Conditions agreement. Click SUBMIT to finish your application.

4Confirmation Email

Check your email and verify if you have received the confirmation email. If you do not receive this email, you must resubmit the form.

5Application Status

You will receive an email with the status of your application.

6Pay the Fees

If your application is approved, the fees will be included in the student account.

Add donotreply@gallivan.ca to your address book. Please do not reply to this email.

Questions? Please contact your Benefit Plan Office: nsccplan@mystudentplan.ca

Health and Dental Re-Enrollment Form

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

Sex

FMU

Date of Birth

Date Month Field Date Day Field Date Year Field

Phone Number

Phone Area Number Phone Local Number Phone Digits

Campus

Program Name

Program Start Date

Date Month Field Date Day Field Date Year Field

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.