Am I Covered

Forms

Are you looking for individual insurance? If you are not automatically enrolled in the student plan or have missed the enrolment period to add family to the student plan, there are personal insurance solutions available. Click here to learn more.

Eligibility Criteria

The health and dental plans were approved by student referendum and as a result are now a requirement of your enrolment at Western University. The plans provide protection and security for eligible students minimizing the effects of injury or ailments. Enrollment is automatic and the cost of the plans are included in your institutional fees, provided you meet these eligibility criteria:

1) enrolled as a full-time student* at the University of Western Ontario, and
2) must be residing in Canada, and
3) Covered under a Provincial Health Care Plan or equivalent.

* Students taking a reduced course load due to documented disability are considered full-time equivalent but are not automatically enrolled or charged. (Please see below)

** For 2020-2021 International Students who studied in your home country please click here for details for submitting eligible claims.

Undergraduate students are eligible for both the health and dental plans. Please confirm eligibility and start dates with the USC plan administrator.

MBA students are eligible for the health plan only. Please confirm eligibility and start dates with the USC plan administrator.

*Full-time equivalent students & students over 65 years of age must be assessed during the first semester of the academic year. EACH YEAR, you are required to complete the opt-in form during the applicable window. No exceptions can be made.

Registered for full-time classes in the Fall? – that is your opportunity to enroll, and you must submit the form, provide documentation, and pay the fee before the Fall deadline.

If you are unsure about whether or not you are eligible for the Student Health and Dental plan, please contact the USC plan administrator prior to any applicable deadlines.

Do you need individual insurance? If you are not eligible for the student plan there are personal insurance solutions available. Click here to learn more.

Coverage Period

For eligible students starting in the fall semester, coverage begins September 1st and ends August 31st.

Family Coverage

Coverage provided through the Student Health and Dental Plan can be extended to a spouse and/or dependent(s). To add eligible dependent(s) you must complete the online form and provide the fees prior to the applicable intake deadline. The Student must also be enrolled in the Student Health and Dental Plan.

IMPORTANT! The fees for Family Add-on are in addition to the student health and dental fee. Your optional family add-on is not automatically renewed. For your family add-on to continue, you must purchase the coverage each benefit year before the applicable deadline.

FAMILY ADD-ON FEES ARE NON-REFUNDABLE.

Spouse Eligibility

Spouse is defined as your spouse by marriage or under any other formal union recognized by law, or your common-law spouse.

Common-Law Spouse is a person who has been living with you in a conjugal relationship continuously for a period of not less than one year or who is the natural or adoptive parent of a child of who you are also the parent.

Spouse means the person who is residing in Canada, and who is married to the student, or a person of either sex who has continuously co-habitated with the student for a period of at least one year and who is publicly represented as the student’s wife or husband.

Dependent Children Eligibility

Children are defined as your natural children, stepchildren, legally adopted children, and children for whom you/and or your spouse have been appointed as guardian(s) for all purposed pursuant to an Order of the Court. NOTE: if the child is your stepchild or your spouse’s adopted child or a child for whom your spouse has been appointed guardian, both your spouse and the children must reside with you full-time. In addition, the child must be:

1)Unmarried
2)Under 21 years of age and not employed full-time
3)Under 25 years of age, if they are attending a college or university full-time, or
4)Physically or mentally incapable of self-support and became incapable to that extent while entirely dependent on the student for maintenance and support and while eligible under 1) or 2) above

NOTE: Parents, Grandparents, Siblings are not eligible dependents.

Please read and agree to the Terms & Conditions prior to submitting your online Family Add-On form.

Do you need insurance for your family members? If you have missed the enrolment period to add family to the student plan or are looking for other coverage for your family, there are personal insurance solutions available. Click here to learn more.

Coordination of Benefits

How to Get 100% Coverage

Use More Than One Plan to Maximize Your Coverage!

Do you have more than one benefit plan? Student Plan, Parent's Plan, Employer Plan or Spouse's Plan?
If so, those plans can to work together to make sure you're getting the most out of your coverage.
One plan becomes your primary plan. It pays your claims first. Then the second plan pays toward the remaining cost.

Students who have health or dental coverage through their school: these plans will always pay before any plan where the student is covered as a dependent.

Example:
A student has health coverage through the university plan, but is also still eligible under a parent's plan as a dependent. Therefore - the school plan pays first.

This process is called coordination of benefits and it's easy to do!

IMPORTANT – Take a copy of your original receipt before you send it to your primary plan as you will need to send a copy to the secondary plan.

Submitting Claims For Yourself:
Submit the claim to your Student Plan first (this is your primary benefit plan).
Next, an unpaid portion can be submitted to your Parent's Plan, Employer Plan or Spouse's Plan (this is your secondary plan).

If you have more than one plan where you are the primary insured (Student Plan and
Employer Plan) your primary plan is the one you have had the longest.
Submit the claim to the plan you have had the longest (this is your primary benefit plan).
Next, an unpaid portion can be submitted to the plan you have had the second longest
(this is your secondary plan).

Submitting Claims for Your Spouse (if applicable):
Submit the claim to your spouse's plan first (this is their primary benefit plan).
Next, an unpaid portion can be submitted to your Student Plan (this is their secondary plan).

Submitting Claims for a Dependent Child (if applicable):
Submit the claim to the parent's plan whose birthday falls first in the year (this is their primary benefit plan).
Next, an unpaid portion can be submitted the parent's plan whose birthday falls second in the year (this is their secondary plan).

ALWAYS REMEMBER!
Include a copy of the Explanation of Benefits statement received from the first claim submission (primary plan), as well as a photocopy of the originally submitted receipt when you submit to your secondary plan.

Change my Coverage

When considering opting-out of your coverage, keep in mind the following:

myvirtualdoctor-new virtual health care service is included in your health plan until August 31, 2023. Upon a successful referendum, February 7 – 10th, beginning September 1, 2023 the myvirtualdoctor service will no longer be included in the health plan and will be a standalone service. If you opt-out of the health plan you will not have access to this service now or after September 1, 2023 as a standalone service.
What is in the best interest of my overall health and well-being?
Does my existing coverage meet all the needs that I may have?
A parent's insurance plan will stop covering you completely if you’re a part-time student over 21 or a full-time student over the age of 25. Proof of enrolment will be required.
In order to cover all of your needs you can combine your student Health Plan with another plan for up to 100% coverage. To get more information about claiming and coordinating your benefits with another plan, read through the “Benefits Plan Claims” link here.

Already have coverage?

Coordinating multiple plans: If you are an eligible student and have comparable coverage you may wish to coordinate your plans. Benefits under the two plans can be coordinated to increase your coverage up to 100% of the actual expense(s) incurred. For example, following payment under this plan you can submit outstanding balances to the other plan for consideration. Find out more about coordination of benefits.

Opting Out of coverage: If you are an eligible student and have comparable health coverage you may apply to opt-out of the plan(s). Each student is given one opportunity to opt-out of the health and/or dental plan(s) each year. All opt-out forms must be completed online and must be received by the applicable deadline. If you have used the health or dental plan, you will not be able to opt-out. You will not be able to opt-out of coverage at any other point during the school year. NO EXCEPTIONS will be made if the deadline is missed. It is the students responsibility to pay the plan fees, should they miss the applicable opt-out deadline.

Extended Health Coverage – Proof of Required (OHIP/UHIP ARE NOT SUFFICIENT TO OPT OUT). You are required to provide proof of your comparable extended health coverage by attaching documentation displaying the policy information you first entered after clicking 'YES' to opt-out of the health plan in the Opt-out Form.

Confirmation of coverage must show the name of the insurance company providing the coverage and the policy number. Acceptable forms of confirmation of coverage are:

Copy of a benefits card (front and back images)
Confirmation letter from the employer or insurance company with a current date
Recent health care claim statement with a current date (within 3 months of application submission).
Webpage print out with a visible current date

Please note: To be considered a comparable health plan, the alternate coverage must include prescriptions, vision, paramedical practitioners, counselling, and more.
*If you upload any dental, Life, or AD&D insurance documents as proof, the opt-out request will be denied, and a new form must be submitted before the deadline providing the required proof.

Approval of your opt-out will result in the fee being credited to your Western tuition account after the deadline passes. Once your opt-out has been accepted, it will remain in force for that benefit year only.
You must fill out an Opt-out Request form each academic/benefit year.

If you are unsure about whether or not you are eligible for the Student Health and Dental plan, please contact the Campus Administrator prior to any applicable deadlines.

Please read and agree to the Terms & Conditions prior to submitting your online opt-out.

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

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

Required Direct Deposit Information

Please enter your financial institution's Transit Number, Institution Number, and Account Number. (*mandatory fields)

** Please do not enter any dashes or spaces **

Transit #

Institution #

Account #

Opt In

When considering opting-out of your coverage, keep in mind the following:
-What is in the best interest of my overall health and well-being?
-Does my existing coverage meet all the needs that I may have?
-A parent's insurance plan will stop covering you completely if you’re a part-time student over 21 or a full-time student over the age of 25.
-In order to cover all of your needs you can combine your student Health Plan with another plan for up to 100% coverage. To get more information about claiming and coordinating your benefits with another plan, read through the “Benefits Plan Claims” link here.

If a student has successfully completed an opt out but requires re-enrolment into the plan there are 2 opportunities to do so:

1) Upon Policy Anniversary: For students starting in September the anniversary would be the following September prior to the applicable deadline.

2) Lifestyle Change: There are certain circumstances known as lifestyle changes that allow a student to make changes to their enrolment status within 30 days of the change. Lifestyle changes include; getting married or meeting the twelve month co-habitation requirement for common law status, birth/adoption of a child, meeting provincial plan residency requirements and losing their alternate coverage.

Students who lose their comparable coverage may opt back into the plan(s), provided that they are within 30 days of losing coverage. If a student has lost their comparable coverage they must show documentation of loss by submitting a letter from either the insurance carrier or employer.

Student Benefits Plan coverage is provided to eligible students automatically, except in certain circumstances where a student’s enrolment status excludes them from automatic inclusion by the institution. To enroll in the Student Health and/or Dental plan(s), complete the sections below and submit this form. You will then be contacted by the Student Benefit 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 enrolment process to be completed.

Please read and agree to the Terms & Conditions prior to submitting your online enrolment form.

You must only complete this form if you are deemed an eligible student (See Eligibility Criteria) and were not charged the fees.

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

Program Name

Program Start Date

Date Month Field Date Day Field Date Year Field

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.

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

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 cumberlandplan@mystudentplan.ca after completing this form.

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

The deadline is within 30 days of the lifestyle change.

Deadline example for new & 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 add dependents would be next September.

Family Add-On Fees:

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Health	$126.00	Health	$126.00
Dental	$126.00	Dental	$252.00
Health & Dental	$252.00	Health & Dental	$378.00

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-on are non-refundable.

Important notes:

If you started your program in a different month than the current one, your request to add family will not be approved at this time. Your next opportunity to extend your plan would be the next anniversary of the start date of your program.
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 1^st 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-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.
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-on are non-refundable.
NO EXCEPTIONS will be made if the application or payment is missed. It is the student's responsibility to check their BVC emails regarding deadlines.
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: cumberlandplan@mystudentplan.ca

health and Dental Family Add-On 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

Program Name

Program Start Date

Date Month Field Date Day Field Date Year Field

Am I Covered

Forms

Eligibility Criteria

Coverage Period

Family Coverage

Coordination of Benefits

Change my Coverage

Student Information

Required Direct Deposit Information

Opt In

Student Information

Health and Dental Family Add-On Application

Eligibility Criteria

Family Add-On Fees:

Steps to Submitting a Family Add-On Application:

health and Dental Family Add-On Form

Student Information

Service Members