Extension and request to add dependents

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Don’t neglect your health, extend your insurance coverage.

 

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

  • Check the annual membership fee on your student association’s page → planmajor.ca.
  • Fill out and sign the form.
  • To submit the documents via a secure link to protect your personal information, click here: Request a secure link
  • Or email the form to the following address → student@majorplan.ca
  • Wait for your application to be reviewed. A member of our team will contact you within 7 business days to confirm the membership fee and payment terms.
  • Upon receipt of payment, a confirmation will be emailed to you within 7 business days. Keep this confirmation for your records.
Download the form