Family Add On
Deadline: September 23, 2022
Coverage provided through the Student Health and Dental Plan can be extended to
a spouse and/or dependent(s). To add eligible dependent(s) complete the
sections below and submit this form. The Student will be contacted via email by
the Benefit Plan Office of any required supporting documents and fees. All
supporting document(s) and fees must be received by the applicable deadline in
order for the family add on process to be completed. The Student must also be
enrolled in the Student Health and Dental Plan.
IMPORTANT! The fees for Family Add-on are in addition to the
student health and dental fee.
Spouse
Eligibility
Spouse is defined as
your spouse by marriage or under any other formal union recognized by law, or
your common-law spouse.
Common-Law Spouse is
a person who has been living with you in a conjugal relationship continuously
for a period
of not less than one year or who is the natural
or adoptive parent of a child of who you are also the parent.
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 Children Eligibility
Children are defined as your natural
children, stepchildren, legally adopted children, and children for whom you/and
or your spouse have been appointed as guardian(s) for all purposed pursuant to
an Order of the Court. NOTE: if the child is your stepchild or your spouse’s
adopted child or a child for whom your spouse has been appointed guardian, both
your spouse and the children must reside with you full-time. In addition, the
child must be:
Unmarried
Under 21 years of age and not employed full-time
Under 25 years of age, if they are attending a college or university full-time, or
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
NOTE: Parents,
Grandparents, Siblings are not eligible dependents.
2021 - 2022 Family Add-On Fees:
Health (one or more dependent) $103.00
Dental (one dependent) $100.00
Dental (two or more dependents) $190.00
FAMILY
ADD-ON FEES ARE NON-REFUNDABLE.
Please read and agree to the Terms & Conditions prior to
submitting your online Family Add-On form.
Have a safe and healthy year!
Thank you
SU Health and Dental Plan Office
2500 University Drive NW
MSC 352
Calgary AB T2N 1N4
Phone: 403-220-3906 • Fax: 403-282-2729
Email: uofcalgaryplan@mystudentplan.ca