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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 lost your comparable coverage plan and wish to re-enroll or if you are a full-time equivalent student, or MBA student, or are over 65 years of age and wish to opt-in to the plan.
All new or returning eligible students, including students who previously opted out, are automatically enrolled in the Health and Dental plan.

Eligibility Criteria

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

1 Loss of Comparable Coverage

Students who previously opted out of the benefits, have lost their comparable insurance coverage, and are still eligible for the plan may re-enroll in the student plan within 30 days of losing that coverage.

Proof of losing coverage must be sent to healthdental@westernusc.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.

2 Full-time equivalent students, MBA students and students over 65 years of age

New or returning students taking a reduced course load due to documented disability, enrolled in the MBA program, or student over 65 years of age may opt-in to the Plan by completing the online form by the applicable deadline.

Proper documentation to confirm your full-time equivalent must be sent to healthdental@westernusc.ca after completing this form.

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

Important notes:
  • Students who previously opted out of the benefits are automatically enrolled in the Plan every Fall term.
  • All international and domestic 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. If you see the Health & Dental Fee included in your tuition, you are covered by the Health and Dental Plan and not need to apply.
  • The effective date of your coverage is the September 1st for the fall enrollment and for losing coverage the effective date is the 1st day of the month when your application is approved.
  • 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.
2Enrolment 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: healthdental@westernusc.ca

Health and Dental Re-Enroll or Opt-In Form



Student Information

Sex
Date of Birth
Phone Number
Program Start Date

USC Benefits Plan Office

Email: healthdental@westernusc.ca
Address: University Community Centre
Room #320
1151 Richmond St
London, Ontario N6A 2K5

General Inquiries Line

Monday to Friday from 8:00am to 7:00pm EST

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