The U | StFXSU - Family Add-On 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.

Health and Dental Family Add-On Application

Winter deadline to submit applications
January 30^th, 2024

Eligible students who are enrolled in the Benefit Plan may apply by the applicable deadline to extend their coverage to their dependents.

Eligibility Criteria

There are 2 circumstances for adding family members to the Student Health and Dental Plan:

1 Academic Enrollment

Eligible students who wish to extend their benefits to their dependents may apply in fall or winter enrollment:

Fall Enrollment: Eligible students may apply to add their dependents to the benefit plan before the fall deadline.
Winter Enrollment: Only new and returning eligible students who have NOT attended the fall term may apply to add their dependents by the winter deadline.

If you miss the term deadline, the next opportunity to add family members will be next fall.

Winter 2024 deadline is January 30^th, 2024

2 Lifestyle Change

Students enrolled in the plan who have a lifestyle change such as getting married, meeting the twelve-month co-habitation requirement for common law status, or birth/adoption of a child who wish to extend their plan to their dependents may apply within 30 days of lifestyle change.

To apply, please email proof of Lifestyle Change to the Benefit Plan Office at stfxplan@mystudentplan.ca. If you are eligible to add family members, the office will send a link for the application.

Documentation includes a marriage certificate, birth certificate, or adoption documents.

Deadline is within 30 days of lifestyle change

Family Add-On Fees:

ONE FAMILY MEMBER		TWO OR MORE FAMILY MEMBERS
Health	$715.00	$715.00
Dental	$654.75	$735.75
Health & Dental	$1,369.75	$1,450.75

The Family Add-On Fee includes the fee for eligible students
If the Family Add-On application is approved, the fees will be added to your student account and must be paid within 30 days.
The fees for Family Add-on are non-refundable.
These are the current family Add-on fees. However, the fees are subject to change without notice.

Important notes:

You can only extend your plan to your spouse or partner and your children. Parents, grandparents, and siblings are not eligible dependents to extend your plan. Please check the eligible dependents.
The family members would be covered by the same plan the student has.
The benefit year coverage is the same for students and family members. For eligible students starting in the fall semester, coverage begins September 1^st and ends August 31^st. For eligible students starting in the winter semester, coverage begins January 1^st and ends August 31^st.
Family Add On requests and fees are not automatically renewed. If students wish to keep the coverage, they must submit a new Family Add-On Application and must pay the additional fees every year by the applicable deadline. The fees will be added to your student account and must be paid within 30 days.
There is a 45-60 day validation period from the start of the program. 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.
Each family member uses the same card that the student has. The card must have the student's information (Student full name and student ID).
The fees for Family Add-on are non-refundable.
NO EXCEPTIONS will be made if the application or payment deadline is missed. It is the student's responsibility to check their emails and make the payment.
Once you submit the Family add-on form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting a family add-on request.

Steps to submitting your Family Add-On:

1 Student Information

Complete this section below providing true and correct information. Click NEXT.

2 Dependent Information

Scroll down and check Spouse/Child/Children according to the members you wish to add. Provide full name, initials, gender, and date of birth for each member. Click NEXT.

3 Read 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.

4 Confirmation 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.

5 Application Status

You will receive an email with the status of your application.

6 Pay Fees

If your application is approved, the family fees will be included in your account and be part of the tuition.

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

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

Health and Dental Family Add-On Form

Please complete all information on the family add-on 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

Online Forms Deadline
Submit your online Family Add-On or Opt-In applications by January 30^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.

STFXSU Benefits Plan Office

Email: stfxplan@mystudentplan.ca
Address: 5555 Union Place
4th Floor Bloomfield Centre, Room 403
Antigonish, Nova Scotia. B2G 2W5

General Inquiries Line

Monday to Friday from 10:00am to 9:00pm AST

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

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