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Individual Enrolment Form

Student Benefits Plan coverage is provided to eligible students automatically, except in certain circumstances where a student's enrollment status excludes them from automatic inclusion by the institution or due to a previous waiver on file. To opt into the Student Health and/or Dental plan(s), complete the sections below and submit this form. You will then be contacted by the NSCC Student Benefits Plan Office, via an email notification, of any required supporting documents and/or fees. All supporting document(s) and/or fees must be received by the applicable deadline in order for the re-enrollment process to be completed.

Student Opt-In

Student Benefits Plan coverage is provided to full-time eCampus students on an opt-in basis. To opt into the Student Health and/or Dental plan(s), complete the sections below and submit this form. You will then be contacted by the NSCC Student Benefits Office, via email notification, to confirm your enrollment. The Opt-In form must be submitted before the applicable deadline.
Full-time eCampus students who are opting into the Student Benefits Plan within the applicable deadline will have the fee added to their student account once the Opt-In form has been processed and approved by the Benefits Plan Office.

Loss of Coverage Opt-In

Students who opted out of the Student Benefits Plan and lost their alternative, comparable coverage can choose to opt into the plan for the remaining months of the benefit year. Students must submit the Opt-In form within 30 days of losing their coverage.
Students opting into the Student Benefits Plan based on loss of coverage will receive an email with fee payment details once the opt-in form has been processed by the Benefits Plan Office.

Please read and agree to the Terms & Conditions prior to submitting your online re-enrollment form.

Student Information

Sex
Date of Birth
Phone Number
Program Start Date

Please enter the date you lost the coverage


           
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