Extension and Request to add dependent children
AETELUQ

 
 

This form is for students who wish to add dependent children and/or extend their coverage. Requests for changes to AETELUQ coverage must be received no later than 30 days after coverage begins.

 
IMPORTANT: Be sure to include all supporting documentation necessary to assess your file (birth certificate, proof of marital status, statement of account and other documents). If supporting documentation is not received within 30 days of the start of your coverage period, your application will be denied. Also, be sure to contact Plan Major to find out the cost of the contribution that applies to your situation, as well as your coverage period.
 

Extension of coverage: Cost of the contribution = $198 for 12 months of coverage (extension of 8 additional months to the initial 4 months)

Adding dependent children: In order to add dependent children, you must extend your current AETELUQ coverage (add 8 months) and add your children for a period of 12 months.

Cost of the contribution for adding dependent children: $297 for 12 months of coverage

 

2 payment options are available (the contribution must be paid in one (1) payment)

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