Request to add dependents

This form is for students who wish to extend their coverage to their dependent children and/or spouse. In the winter semester, the addition of dependents is only available to new students. Please note that if the primary insured member loses their student status or coverage, their dependents automatically lose their coverage without the possibility of a refund.
IMPORTANT: Be sure to include all the supporting documentation necessary to assess your file (birth certificate, proof of marital status, account statement and other documents). If the supporting documentation is not received by the end of the modification period, your request to add a dependent may be denied. Also, be sure to contact Major Plan to find out the cost of the contribution that applies to your situation.
Contribution cost per dependent = Annual contribution to your association’s plan 


1. Complete and sign the form.
2. Send the form to
3. Our team will then analyze your application and contact you within 5 working days. Please wait for confirmation from a member of our team as to the amount of the membership fee to be paid, and the payment terms and conditions.
4. Once payment has been made, an e-mail confirmation will be sent to you within 7 working days, confirming that your application
has been registered. Keep this e-mail.

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