SAMRU - 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.

Re-enroll Applications

Submit your health and/or dental re-enroll application before the deadline.

Fall Application Period

August 1^st, 2024 to September 27^th, 2024

Make sure to submit your form by September 27^th as the online form will be accessible only to eligible students who have lost their comparable coverage.

Re-Enroll Eligibility

There are 2 circumstances in which students who opted Out of the Student Health and Dental Plan may Re-Enroll: (1) when they are starting the fall term, or (2) when they are within 30 days of losing their alternate Health and Dental coverage.

Eligibility to Re-Enroll

How to Re-Enroll

To apply to Re-Enroll, you must be opted out of the Student Plan, meet the Re-Enroll eligibility criteria, are eligible for the Student Plan, and complete the online form before the applicable term deadline.

Steps to Re-Enroll

Things to consider:

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 the Health Insurance Fee and the Dental Insurance Fee on your student account to confirm you are enrolled.
Students choosing to re-enroll in the Health, the dental or both plans.
Approval of the Student Benefits Plan re-enrollment application will result in the Health Insurance Fee and/or the Dental Insurance Fee being assessed on your student account.
NO EXCEPTIONS will be made if the application or payment is missed. It is the student's responsibility to check their emails regarding the status of the application or deadlines.

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

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

The winter re-enroll deadline is closed.

The winter deadline to apply was January 26^th, 2024. The online Re-Enroll Form is not available at this time. The online form was open from December 1^st, 2023, until Januarry 26^th, 2024.

NO EXCEPTIONS will be made if the deadline is missed. The online form will be open for all eligible fall students on August 1^st, 2024, and the deadline to apply is September 27^th, 2024.

The online form is only available for students who have lost their comparable coverage.

Health and Dental Re-Enrollment 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

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

Fall Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by September 27^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.

SAMRU Benefits Plan Office

Email: mtroyalplan@mystudentplan.ca
Phone: 403-440-6267
Address: Room Z001, Wyckham House
4825 Mount Royal Gate SW
4500-50 Street
Calgary, Alberta. T3E 6K6

General Inquiries Line

Monday to Friday from 6:00am to 5:00pm MST

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

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