SAOC - Enrollment Form

Student Health & Wellness!mystudentplan is a benefits plan for students and can provide coverage for prescription drugs, vision care, dental care, mental health counseling, and more. The plan is designed to supplement provincial health insurance and provide additional access to medical services.

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.

Health and Dental Re-Enroll or Opt-In Application

Only submit this form if you have previously opted out of the health and dental plan and wish to re-enroll or if you are a part-time student considered full-time due to a developmental disability. All new or returning eligible students are automatically enrolled in the benefit plan.

Eligibility Criteria

There are 2 circumstances for re-enrolling and 1 circumstance for opting into the Student Health and Dental Plan:

1 Anniversary of Starting an Eligible Program

Eligible students who previously opted out of the benefits can re-enroll on the start on the anniversary of starting their program by the applicable deadline.

Deadline example for returning students: If your program starts on September 6^th, you may submit an online application before October 6^th. If you miss the deadline, your next opportunity to re-enroll would be next September.

The deadline is 30 days from the official start date of your program.

2 Loss of Comparable Coverage

Eligible students who previously opted out of the benefits and have lost their comparable insurance coverage may re-enroll within 30 days of losing that coverage.

Proof of losing coverage must be sent to oldsplan@mystudentplan.ca after completing this form.

Documentation includes a letter from the insurance carrier or the employer stating the student's name, loss of coverage date, the insurance carrier's name & policy number.

The deadline is within 30 days of losing coverage.

3 Eligible Exclusions

Students who are considered full-time due to a developmental disability or are in a program that isn't automatically charged may be eligible to opt into the plan within the first 30 days of their program, or within 30 days of their coverage renewal date if the student has previously been on the plan but is not automatically enrolled.

The deadline is 30 days from the official start date of your program.

Important notes:

Eligible students are automatically enrolled in the Student Health and Dental Plan and do not need to submit a Re-Enroll or Opt-In form. You will see a health fee and dental fee on your student account to confirm you are enrolled.
The student enrollment is NOT automatically renewed. In order for the student Re-Enroll or 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 term. 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.
NO EXCEPTIONS will be made if the deadline is missed.
Once you complete the Re-Enroll or 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 Re-Enroll or Opt-In request.

Steps to Submitting a Re-Enroll or Opt-In Application:

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: oldsplan@mystudentplan.ca

Health and Dental Re-Enroll or Opt-In Form

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

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

Sex

F

M

U

Date of Birth

Date Month Field Date Day Field Date Year Field

Phone Number

Phone Area Number Phone Local Number Phone Digits

Program Name

Program Start Date

Date Month Field Date Day Field Date Year Field

Online Forms Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications within 30 days from the start date of your program.

Plan Card Generator
Generate your Plan Card and use it where direct billing to Canada Life is available.

Prescription Search Tool
Find out if your prescription drugs are covered by the student plan.

Plan Claims
Learn more about submitting online or manual claims to Canada Life to get your refund.

SAOC Benefits Plan Office

Email: oldsplan@mystudentplan.ca
Phone: 403-556-4626
Address: Bell e-Learning Centre
3Room 921
4500-50 Street
Olds, Alberta. T4H 1R6

General Inquiries Line

Monday to Friday from 6:00am to 5:00pm MST

Phone: 1-877-746-5566 Ext. 7249

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