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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.

Direct Deposit Info Form

Please complete this form if you have previously opted out of the student benefits plan and would like to update your direct deposit information. This will change the banking details for where your opt-out reimbursement will be deposited. Please double check the information provided below before choosing submit to ensure the account details are accurate.
First Name
Last Name
Student ID
Email
Phone Number


Required Direct Deposit Information

Please enter your financial institution's Transit Number, Institution Number, and Account Number.
info graphic
Transit #
Institution #
Account #


Terms and Conditions

Do you accept the Terms and Conditions?
Yes

Opt In


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. For students starting in January the anniversary would be the following January 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 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 Health & Dental 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

Sex
Date of Birth
Phone Number
Program Start Date

Family Add On


Each year, you are given one opportunity to purchase family coverage for your spouse and/or dependent(s) by completing an application through the On Campus Health & Dental Plan Office and paying the family coverage fee. All family add-on forms and applicable fees must be received no later than 30 days after the start of your program. Your family can only be covered while you are a student on the plan(s).
IMPORTANT: These fees are in addition to the student health and dental fee.
2021 - 2022 Family Add-On Fees:
Health (one dependent):  $207.00
Health (two or more dependents):  $345.00
Dental (one dependent):  $176.00
Dental (two or more dependents):   $293.00
Please note: Your optional family add-on is not automatically renewed. In order 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 means the person who is a resident of 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 means an unmarried child who is a resident of Canada, and entirely dependent on the student for maintenance and support, and who is:
1) under 22 years of age,
2) under 26 years of age and attending a college or university full-time, or
3) 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.
To add family coverage to your Student Health and Dental plan submit the completed Family Add-On Form, along with the required fees to the Health & Dental Plan Office, before the established deadline.

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

Student Information

Sex
Date of Birth
Phone Number
Program Start Date

Health and Dental Opt Out

mylegalplan - Legal coverage and myvirtualdoctor - New virtual health care service are included as part of the health plan. If you opt-out of the health plan, you opt-out of these services. Learn more about your health plan details to make an informed decision.


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 and/or dental 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 or through the Student Benefits Plan Office and must be received within 30 days from the start date of your full-time program. 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 student's responsibility to pay the plan fees, should they miss the applicable opt-out deadline.

Approval of your opt-out will result in the plan fee being credited. Once your opt-out has been accepted, it will remain in force as long as you remain an eligible student.

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

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

Student Information

Date of Birth
Phone Number
Program Start Date

Service Members


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