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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.

Submitting Online Applications

Before submitting your online forms, please review the eligibility criteria and read the Terms and Conditions.

Opt-Out Application

If you are covered by a comparable Health and Dental Plan from parents, spouse, work, government, or band and do not wish to Coordinate Benefits, you may submit an online Opt-Out application.

Direct Deposit

If you have previously opted out of the student benefits plan and would like to update your direct deposit information, you may submit an online application to change your banking information to get the opt-out reimbursement.

Family Add-On Application

Extend your plan to your dependents and provide the same protection you have. Additional charges that must be paid using a credit card.

Opt-In Application

If you are not automatically enrolled in the Health and Dental Plan but would like to access coverage or if you previously opted out of the plan and have lost your comparable coverage or a lifestyle change occurred, you may opt-in to the Plan.

Deadline to submit applications