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: Major Plan reserves the right to verify and validate eligible documents proving the status of your dependents. Please ensure that you have these documents and can provide them to us within 10 business days. If the supporting documents are not received within this timeframe, your request to add dependents may be refused and cancelled. Also, be sure to contact Major Plan to find out the cost of the contribution that applies to your situation.
Cost of the contribution 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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