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Family Add On

Each year, students are given one opportunity to purchase family coverage for their spouse and/or dependant(s) by completing an application form and paying the family coverage fee. Family coverage is then added during the enrolment processing period.

2021 - 2022 Health & Dental Family Add-On Fees:
Family Health (student plus one or more dependents)   $550.00
Dental +1 (student plus one dependent)   $485.00
Dental +2 (student plus two dependents)   $545.00

To add eligible dependent(s) complete the sections below and submit this form. You will then be contacted by Gallivan & Associates, via an email notification, of any required supporting documents, fees and payment options. All supporting document(s) and fees must be received by the applicable deadline in order for the family add on process to be completed. 

A student’s family can only be covered while they are a student on the plan. For information about eligible family members please refer to the "Am I Covered" tab.

Family coverage must be re-purchased each year and is the student's responsibility to do so by the applicable deadline for their enrolment period.

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

Student Information

Date of Birth
Phone Number
Program Start Date