Students' Union, UCalgary - Family Add On 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 Family Add-On Application

Winter deadline to submit applications
January 26^th, 2024

Eligible students who are enrolled in the Benefits Plan may apply by the applicable deadline to extend their coverage to their dependents.

Health and Dental insurance fees on the student account are for the student only. Students must apply and pay additional fees to have their family members added.

ONLY new eligible winter students or eligible students who started a program in the winter term may apply. If you started in the spring, summer, or fall term, you could not apply in the winter term, your next opportunity would be on the anniversary of starting your program.

Eligibility Criteria

There are 2 circumstances for adding family members to the Student Health and Dental Plan:

1 Academic Enrollment

Eligible students who wish to extend their benefits to their dependents may apply according to the university enrollment:

New Students: Eligible new students who wish to extend their plan to their eligible family members may apply by the applicable term deadline.
Returning Students: Eligible returning students enrolled in their anniversary of starting an eligible program who wish to extend their plan to their eligible family members may apply by the applicable term deadline.

If you miss the term deadline, your next opportunity to apply would be on the anniversary of starting your program. For example: If you are a new student in the Fall term, you are allowed to add family members every fall term.

Winter 2024 deadline is January 26^th, 2024

2 Lifestyle Change

Students enrolled in the plan who have a lifestyle change such as getting married, meeting the twelve-month co-habitation requirement for common law status, or birth/adopting a child and wish to extend their plan to their dependents may apply within 30 days of lifestyle change.

To apply, please email proof of Lifestyle Change to the Benefit Plan Office at uofcalgaryplan@mystudentplan.ca. If you are eligible to add family members, the office will send a link for the application.

Documentation includes a marriage certificate, birth certificate, or adoption documents.

Deadline is within 30 days of lifestyle change

Deadline to Submit Applications

Eligible students must submit their applications before the applicable term deadline. NO EXCEPTIONS will be made if the deadline is missed. Before submitting an application make sure that you meet the eligibility criteria above.

Winter 2023
January 27^th, 2023

Spring 2023
May 12^th, 2023

Summer 2023
July 5^th, 2023

Fall 2023
September 22^nd, 2023

Family Add-On Fees:

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Health	$107.12	Health	$107.12
Dental	$104.00	Dental	$208.00
Health & Dental	$211.12	Health & Dental	$315.12

These are the current Family Add-on fees. However, the fees are subject to change without notice.
These fees are not included in your tuition, and you will pay them with a credit card on our website if your application is approved.
The Family add-on fees cover 12 months of coverage.
Family add-on must be completed every year at the renewal of the student's academic year.
The fees for Family Add-ons are non-refundable.

Important notes:

You can only extend your plan to your spouse or partner and your children. Parents, grandparents, and siblings are not eligible dependents to extend your plan. Please check the eligible dependents.
The family would be covered by the same coverage the student has. The student and the family member do not share the coverage.
The family fees provide coverage for one year. The student needs to keep active in the plan for 12 months. If the student loses the coverage, the family loses the coverage too. The effective date of your coverage would be the 1st day of the month when your program begins.
Family Add-On requests & fees are not automatically renewed and must be submitted/paid every Fall term.
There is a 45-60-day validation period from the start of the program. 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.
Each family member uses the same card that the student has. The card must have the student's information (full name and student ID).
The fees for Family Add-ons are non-refundable.
NO EXCEPTIONS will be made if the application or payment is missed. It is the student's responsibility to check their emails regarding the application.
Once you complete the Family add-on form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting a Family Add-on request.

Steps to submitting your Family Add-On:

1 Student Information

Complete this section below providing true and correct information. Click NEXT.

2 Dependent Information

Scroll down and check Spouse/Child/Children according to the members you wish to add. Provide full name, initials, gender, and date of birth for each member. Click NEXT.

3 Read 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 finish your application.

4 Confirmation 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.

5 Application status

You will receive an email with the status of your application.

6 Pay fees online

If your application is approved, you will receive a link to pay the applicable fees with your credit card and the deadline to pay them.

Add donotreply@gallivan.ca to your address book. Please do not reply to this email.

Questions? Please contact your Benefit Plan Office: uofcalgaryplan@mystudentplan.ca

Health and Dental Family Add-On Form.

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

Sex

FMU

Date of Birth

Date Month Field Date Day Field Date Year Field

Phone Number

Phone Area Number Phone Local Number Phone Digits

Campus

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 by January 26^th, 2024

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.

Online Forms

Health and Dental Family Add-On Application

Eligibility Criteria

Deadline to Submit Applications

Family Add-On Fees:

Steps to submitting your Family Add-On:

Health and Dental Family Add-On Form.

The fall Family Add-On deadline is closed

Student Information

SU Benefits Plan Office

General Inquiries Line

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