Student Health and Wellness! mystudentplan provides health, prescriptions, dental, mental health care plus additional benefits for eligible students.

 

Health and Dental Family Add-On Application

Deadline to submit applications
30 days from the official start date of your program.

Only new students or returning students whose anniversary of enrollment is the current month who are active in the Student Plan may apply to extend their benefits to their dependents before the deadline.

The fees on the student account are for the student only. Students must pay additional fees to have their family members added to the plan.

Eligibility Criteria

There are 2 circumstances for adding family members to the Student Health and Dental Plan:

1 Academic Enrollment

Students who are eligible for the plan and wish to extend their benefits to their dependents may apply according to the university enrollment:

  • New Students: starting an eligible program and qualifying for the plan who wish to extend their plan to their dependents may apply by the applicable deadline.
  • Returning Students: Returning Students enrolled in the plan and on their anniversary of starting an eligible program who wish to extend their plan to their dependents may apply by the applicable deadline.
2 Lifestyle Change

Students enrolled in the plan who have a lifestyle change such as getting married, meeting the twelve-month co-habitation requirement for common law status, or birth/adopting a child, who wish to extend their plan to their dependents may apply within 30 days of lifestyle change.

To apply, please email proof of Lifestyle Change to the Benefit Plan Office at oldsplan@mystudentplan.ca after completing this form.

Documentation includes a marriage certificate, birth certificate, or adoption documents.

Deadline example for new and returning students:

If your program starts on September 6th, you may submit an online application before October 6th. If you miss the deadline, your next opportunity to add dependents would be next September.

Family Add-On Fees:

ONE FAMILY MEMBER TWO OR MORE FAMILY MEMBERS
Health $195.00 Health $195.00
Dental $195.00 Dental $320.00
Health & Dental $390.00 Health & Dental $515.00
  • These are the current Family Add-on fees. However, the fees are subject to change without notice.
  • These fees are not included in your tuition, and you will pay them with a credit card on our website if your application is approved.
  • The Family Add-on fees cover 12 months of coverage.
  • The fees for Family Add-ons are non-refundable.
Important notes:
  • You can only extend your plan to your spouse or partner and your children. Parents, grandparents, and siblings are not eligible dependents to extend your plan. Please check the eligible dependents.
  • The family would be covered by the same plan the student has. The student and the family member do not share the coverage.
  • The family fees provide coverage for one year. The student needs to keep active in the plan for 12 months. If the student loses the coverage, the family loses the coverage too. The effective date of your coverage would be the 1st day of the month when your program begins.
  • Family Add-On requests & fees are not automatically renewed and must be submitted/paid every year.
  • 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 Plan Card will be automatically activated.
  • Each family member uses the same card that the student has. The card must have the student's information (full name and student ID).
  • The fees for Family Add-ons are non-refundable.
  • NO EXCEPTIONS will be made if the application or payment is missed. It is the student's responsibility to check their emails regarding the application.
  • Once you complete the Family add-on form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting a Family Add-on request.

Steps to Submitting a Family Add-On Application:

1 Student Information
Complete this section below providing true and correct information. Click NEXT.
2 Dependent Information
Scroll down and check Spouse/Child/Children according to the members you wish to add. Provide full name, initials, gender, and date of birth for each member. Click NEXT.
3 Read 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.
4 Confirmation 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.
5 Application status
You will receive an email with the status of your application.
6 Pay fees online
If your application is approved, you will receive a link to pay the applicable fees with your credit card and the deadline to pay them.

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

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

Health and Dental Family Add-On Form

Please complete all information on the family add-on form and we will process your application as soon as we can.



Student Information

Sex
Date of Birth
Phone Number
Program Start Date