Family Add On | Gallivan

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

Winter deadline to submit application January 31^st, 2023

Only students who are eligible for the Student Plan and meet the following eligible criteria may apply to extend their benefits to their dependents before the deadline.

The fees on the student account are for the student only. Students must pay the additional fees to have their family members added to the plan.

Eligibility Criteria

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

1New Students

New eligible students for the Student Plan starting an eligible program in the current term who wish to extend their plan to their eligible family members may apply

2Returning Students

Returning eligible students enrolled in an eligible program who are active on the Student Plan and wish to extend their plan to their eligible family members may apply only in the Fall term

Family Add-On Fees:

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Health	$140.78	Health	$234.65
Dental	$186.98	Dental	$311.63
Health & Dental	$327.76	Health & Dental	$546.28

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 for Fall enrollments and 8 months of coverage for Winter enrollments.
The fees for Family Add-on 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 plan the student has. The student and the family member do not share the coverage.
The family fees provide coverage for 12 months for Fall enrollments and 8 months for Winter enrollments. The student needs to keep active in the plan during this time. If the student loses the coverage, the family loses the coverage too. The effective date of your coverage would be the 1^st day of the month when the term starts.
Family Add On requests & fees are not automatically renewed and must be submitted/paid every Fall term.
There is a 60-45-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 benefits card will be automatically activated.
Each family member use 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-on are non-refundable.
NO EXCEPTIONS will be made if the application or payment is missed.
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: admin@ursu.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

Program Name

Program Start Date

Date Month Field Date Day Field Date Year Field

Online Forms Deadline
Add Family or Opt-in
Submit your applications before: January 31^th, 2023

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