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Family Add On Form

Family Add On

You must be enrolled in the Student Health and Dental Plan to extend coverage to a spouse and/or dependent(s).

To add your spouse and/or dependent(s), complete and submit ​the Family Add-on form. 

​You will be contacted via email by the Benefits Plan Office ​about required supporting documents and fees. All supporting document(s) and fees must be ​paid by the applicable deadline ​to complete the family add on. 

IMPORTANT! Family Add-on fees are in addition to the ​your 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 you, or a person of either sex who has been continuously cohabitating with ​you for a period of at least one year and who is publicly represented as the ​your 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 child 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.

2019 - 2020 Family Add-On Fees:
Health (one or more dependent) $195.00
Dental (one dependent)                      $195.00
Dental (two or more dependents)        $320.00

Please read and agree to the Terms & Conditions ​before submitting your online Family Add-On form.

Thank you

Student Benefits Plan Office
Bell e-Learning Centre
Room 921
4500-50 Street
Olds, Alberta T4H 1R6
Phone: (403) 556-4626 • Fax: (866) 860-3078
Email: oldsplan@mystudentplan.ca

Student Information

Gender
Date of Birth
Phone Number
Program Start Date

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