Student Health and Wellness! mystudentplan provides health, prescriptions, dental, mental health care plus additional benefits for eligible students.

 

Health and Dental Re-Enroll Application

Only submit this form if you have previously opted out of the health and dental plan and wish to re-enroll. All new or returning eligible students are automatically enrolled in the benefit plan.

Eligibility Criteria

There are 2 circumstances for re-enrolling in the Student Health and Dental Plan:

1 Anniversary of Starting an Eligible Program

Eligible students who previously opted out of the benefits can re-enroll on the start on the anniversary of starting their program by the applicable deadline.

Deadline example for returning students: If your program starts on September 6th, you may submit an online application before October 6th. If you miss the deadline, your next opportunity to re-enroll would be next September.

2 Loss of Comparable Coverage

Eligible students who previously opted out of the benefits and have lost their comparable insurance coverage may re-enroll within 30 days of losing that coverage.

Proof of losing coverage must be sent to spsahealth@spsa.ca after completing this form.

Documentation includes a letter from the insurance carrier or the employer stating the student's name, loss of coverage date, the insurance carrier's name & policy number.

If you do not meet the eligibility criteria to be automatically enrolled in the student plan, please do not complete this form. There is no opt-in to the student plan.

Important notes:
  • All domestic and international eligible students are automatically enrolled in the Student Health and Dental Plan and do not need to submit a re-enroll form. To confirm your enrollment, go to your student's statement of account and see if you have been charged the Health and Dental fee on your current tuition.
  • To approve the re-enroll application, students need to qualify for the plan by meeting the Student Plan eligibility criteria.
  • There is a 45-day validation period from the start of the term. 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 for pharmacies and dental offices.
  • If you are submitting this application because of loss of comparable coverage and do not email the proper documentation to spsahealth@spsa.ca, your application will be denied.
  • You must provide a letter from the insurance carrier or the employer stating the student's name, loss of coverage date, the carrier's name, and policy number to process your re-enroll application for losing comparable coverage.
  • You must provide the payment before the applicable deadline to activate your Health and Dental Plan.
  • The effective date of your coverage is the 1st day of the month when your program begins.
  • NO EXCEPTIONS will be made if the deadline is missed.
  • Once you complete the re-enroll form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting a Re-Enroll request.

Steps to Submitting a Re-enroll Application:

1Student Information
Complete this section below providing true and correct information. Click NEXT.
2Enrolment Circumstances
Scroll down and check Health Plan/Dental Plan/Qualify. You can choose Health or Dental or both plans. Select your status and Click NEXT.
3Read 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.
4Confirmation 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.
5Application status
You will receive an email with the status of your application.
6Pay the fees
If your application is approved, the fees will be included in the student account.

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

Questions? Please contact your Benefit Plan Office: spsahealth@spsa.ca

Health and Dental Re-enroll Form

Please complete all information on the re-enroll form and we will process your application as soon as we can.



Student Information

Sex
Date of Birth
Phone Number
Program Start Date