Terms and Conditions
Submission of an online form indicates:
an understanding that it is solely the responsibility of the student whose name and identification number (The Student) is on the form to ensure that the form has been received by the plan administrator;
an understanding that the information provided is required in order fulfill the purpose of the form;
authorization and consent to the use, release and exchange of said information between the educational institution, the student organization, the plan broker, third party service providers and the insurance insurance company(s) to be used solely in connection with the administration of the Student Benefits Plan;
confirmation that all the information provided is accurate; and
that additional terms as indicated below by type of form also apply.
WAIVER/OPT-OUT FORM: The Student wishes to decline the student health and/or dental plan(s) coverage. Comparable health and/or dental coverage are presently provided for the student under another insurance plan. The Student understands that s/he would have been able to claim under his/her existing insurance as well as under the student health and/or dental plan(s), thereby increasing coverage.
Forms must be submitted along with appropriate supporting documentation. Confirmation of existing coverage must show the name of the company providing coverage and the policy number. Incomplete waiver forms including those submitted without confirmation of existing coverage will not be processed.
The Student acknowledges that as a result of the waiver, s/he forfeits all rights to coverage otherwise available to him/her under the student health and/or dental plan(s). The Student realizes that s/he will not be able to rejoin the plan(s) until the policy anniversary or unless s/he ceases to be covered by the insurance used to waive the student health and/re dental plan(s) and apply within 30 days of losing said coverage. The Student must complete the necessary form and proved the necessary proof of loss of insurance in order to reinstate coverage.
After the initial waiver form is processed, the benefits are automatically waived each subsequent school year the student attends the institution.
FAMILY ENROLMENT FORM: The Student understands that information provided above is required to provide the same dental and/or extended health benefits received as a student to spouse and/or dependent(s). The Student has the authority to provide such information and authorizes the use of the information provided where it is required in the administration of the insurance benefits. The Student confirms that all information provided is accurate. The Student understands that in order to receive coverage for an eligible spouse or dependent the appropriate fee must be paid. The Student agrees to pay the appropriate fees for the coverage requested. The Student understands that the coverage provided to the plans will need to be renewed each Benefit Year.
The Student avows that the individual(s) for whom coverage is being requested qualify based on the eligible definitions of spouse or dependant. Definition of Spouse: Spouse means the person who is a resident of Canada, and who is married to The Student, or a person of either sex who has continuously co-habitated with The Student for a period of at least 12 months and who is publicly represented as The Student's wife or husband. Dependant(s): Dependant means an unmarried child who is a resident of Canada, and entirely dependent on The Student for maintenance and support, and who is: 1) under 21 years of age, 2) under 25 years of age and attending a college or university full-time, or 3) 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.
INDIVIDUAL ENROLMENT FORM: The Individual enrolment form can be used in circumstances as indicated below.
In circumstances where The Student’s status makes him/her eligible for the program but s/he has been excluded from automatic inclusion by the institution.
In circumstances where The Student has previously submitted a Waiver which has been accepted and s/he wishes to withdraw the Waiver.
The Student confirms that all information provided is accurate. The Student understands that in order to receive coverage the appropriate fee must be paid. The Student agrees to pay the appropriate fees for the coverage requested.
The Student understands that information provided above is required to provide the dental and/or extended health benefits. The Student authorizes the use of the information provided where it is required in the administration of the insurance benefits.