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

Submitting Online Forms

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

The deadline to submit online forms is 30 days from the official start date of your program.

Deadline example. If the official start date of your programs is September 6^th, you may submit online forms before October 6^th.

Opt-Out Application

Withdraw from the student plan 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 by completing the online form by the applicable term deadline.

Opt-Out Form

Family Add-On Application

Extend your student plan to your dependents and have them covered with the same Health and Dental benefits by completing the online form by the applicable term deadline. Additional charges must be paid using a credit card.

Family Add-On Form

Re-enroll Application

Re-enroll in the student Plan if you previously opted out or have lost your comparable insurance coverage and wish to have extended health and dental coverage by completing the online form by the applicable term deadline.

Re-enroll Form

Opt Out
Deadline: 30 Days from the official start date of your program

myBenefits Card
Card Registration

Prescription Search
Based on the BC Provincial Formulary

myWellness
Click here to take your free mental health assessment.