Request to add dependents
UNIVERSITY

 
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.
 
Cost of the contribution per dependent = Annual contribution to your association’s plan (health, dental, accident and travel)
 

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

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