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Individual Enrolment


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 or due to a previous waiver on file. 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 fees. All supporting document(s) and 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.

Student Information

Gender
Date of Birth
Phone Number
Program Start Date

Service Members


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