Extension and request to add dependents

This form is for individuals who wish to add dependents and/or extend their coverage. Requests for changes must be received no later than 30 days after the start of coverage.

IMPORTANT: This form extends your plan coverage to your dependent children and/or spouse for a maximum period of 12 months. After this period, you will need to re-enroll in a course with your educational institution and send us this form along with payment of the premium during the change period. In addition, be sure to contact Plan Major to find out the cost of the premium that applies to your situation.

Don’t forget to review the eligibility requirements under “Authorizations and Declarations” at the bottom of the form.

To add dependents, you must extend your current coverage (add 8 months) and add your dependents for a period of 12 months.

Steps to follow:

1. Check the annual contribution cost on your student association page.

2. Complete and sign the form.

3. Send the form to etudiant@planmajor.ca.

4. Wait to receive confirmation from a member of our team to find out the amount of the premium to be paid and the payment terms.

5. Please allow 3 to 5 business days for your payment to be received. Our team will then send you an acknowledgment of receipt and your coverage confirmation within 7 business days.