Southeast College - Enrollment Form

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 Opt-In

Deadline to submit application 30 days from the official start date of your program

Only returning students whose anniversary of enrollment is the current month or who have a lifestyle change who previously opted out of the plan may apply to opt-in to the plan before the deadline.

All new eligible students are automatically enrolled in the Student Health and Dental plan, so they do not need to apply for coverage.

Eligibility Criteria

There are 3 scenarios for re-enrolling into the Student Health and Dental Plan:

1Program Start Date

Students who previously opted out of the benefits may re-enroll into the plan at the anniversary term of starting their program before the applicable deadline:

For example: If the student started the program in September 2022, the anniversary will be in September 2023 and the deadline will be in October 2023.

2 Loss of Comparable Coverage

Students who have lost their comparable insurance coverage may apply within 30 days of losing that coverage. You must provide the proper documentation and complete the online form. Documentation includes a letter from the insurance carrier or the employer stating the students' name, loss of coverage date, the carrier's name, and policy number. This documentation must be emailed to southeastcollegeplan@mystudentplan.ca

3Lifestyle Change

Students who previously opted out of the benefits may re-enroll in the plan if they have a lifestyle change within 30 days of the change date. There are certain circumstances known as lifestyle changes such as getting married, meeting the twelve-month co-habitation requirement for common law status, birth/adoption of a child, and meeting provincial plan residency requirements that allow students to apply. You must provide the proper documentation and complete the online form. Documentation includes a marriage certificate, birth certificate or adoption documents. This documentation must be emailed to southeastcollegeplan@mystudentplan.ca

Important notes:

All eligible students are automatically enrolled in the Student Health and Dental Plan and do not need to submit an opt-in form. You will see a health fee and dental fee on your student account to confirm you are enrolled.
If you started your program in a different month than the current one, your request to opt in will not be approved at this time. Your next opportunity to opt-in would be the next anniversary of the start date of your program.
The effective date of your coverage is the 1^st day of the month when your program begins.
There is a 45-day validation period from the start of the term. 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 Plan Card will be automatically activated.
NO EXCEPTIONS will be made if the deadline is missed.
Once you complete the 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 Opt-In request.

Steps to submitting your Opt-In:

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 complete your form.

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: southeastcollegeplan@mystudentplan.ca

Health and Dental Opt-In Form

Please complete all information on the re-enroll form and we will process your application as soon as we can.

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

Sex

F

M

U

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

Online Forms Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications within 30 days from the start date of your program.

Plan Card Generator
Generate your Plan Card and use it where direct billing to Canada Life is available.

Prescription Search Tool
Find out if your prescription drugs are covered by the student plan.

Plan Claims
Learn more about submitting online or manual claims to Canada Life to get your refund.

Southeast College Benefits Plan Office

Email: southeastcollegeplan@mystudentplan.ca

General Inquiries Line

Monday to Friday from 7:00am-6:00pm CST

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

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