York Univ (Graduate Students)

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Disclaimers

There will be no indication of any special authorization or patient exception drug allowances.
There will be no actual coverage amounts included. In fact the student plan is a generic one and the eligible costs are based on generic equivalents if they exist.
There will be no provincial breakdowns and some DINS may possibly be included in one province and not in another.

Compassionate and confidential care for your health and wellness

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eProfile for Online Claims Submission

Booklets & Forms

eProfile for Online Claims Submission

Booklets & Forms

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Accident Benefits for All Plans

Travel for All Plans

Student Wellness Programs for All Plans

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Accident Benefits for All Plans

Travel for All Plans

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Part Time Opt In

Part Time/Graduate Student Opt-In

Choose Your Plan

Family Opt In

Opt Out

Check Drug Coverage

Virtual Doctors

Flex Plan

Choose your plan is only available to students starting in January

HAVE YOU OPTED IN? This is not an application to opt into the benefits. You cannot choose an enhanced plan until you have already completed an opted in application and paid the necessary fee. If you have not paid the opt-in fee ($325 single coverage, $650 single +1 dependant, $850 single +2 or more dependants) you are not eligible to choose a plan.

ARE YOU A STUDENT STARTING IN JANUARY? THIS OPTION IS ONLY AVAILABLE TO STUDENTS STARTING CLASSES IN JANUARY 2019. IF YOU STARTED CLASSES DURING ANY OTHER DATE, YOU CANNOT CHOOSE A PLAN AT THIS TIME.

Please select your program

You need to input a valid value for field: School

Please only list the last 9 digits of your student ID number Last 7 digits of your Student Number Please enter your Student ID number

You need to input a valid value for field: Student ID number

This Student ID has already made a change of plan for this session.
You will be able to change plan again after this date: {{flexPlanModal.expiryDate}}

PlanDisplay plans overview

First Name

You need to input a valid value for field: First Name

Last Name

You need to input a valid value for field: Last Name

Date of birth - (Year / Month / Day)

Sex

You need to input a valid value for field: Sex

You need to input a valid value for field: Email

Please select this checkbox to indicate that you have read and agreed with our Plan Terms & Conditions.

I understand that I cannot change my plan after confirming as per plan terms.

Please review your data and confirm your decision:

Student ID number	{{flexPlanModal.data.studentNumber}}
Plan Selected	{{flexPlanModal.choosenPlanTitle}}
First Name	{{flexPlanModal.data.firstName}}
Last Name	{{flexPlanModal.data.lastName}}
Date of Birth	{{flexPlanModal.data.dateOfBirth \| date: 'yyyy-MM-dd'}}
Sex	{{flexPlanModal.data.sex \| ucfirst}}
Email	{{flexPlanModal.data.email}}

Please wait while your FlexPlan is registered.

Confirmation #{{flexPlanModal.confirmationNumber}}

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Your SpeakUp flexible Insurance plan details will be emailed to you shortly.

Thanks for Speaking Up!

Print Confirmation

Cannot be undone

Part Time Student Opt-In

Family Opt-In

Student information

Dependents information

Please select your program

You need to input a valid value for field: School

Available options rates

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{{lakeheadCustomizePartTimeName(option)}}	${{price}}

Eligibility Requirements

Terms & Conditions

Please only list the last 9 digits of your student ID number Last 7 digits of your Student Number Please enter your Student ID number

You need to input a valid value for field: Student ID number

I Agree

This Student ID has already Opt-In for this session.
You will be able to Opt-In again after this date: {{optinModal.expiryDate}}

Sorry this Opt-In session is over.

First Name

You need to input a valid value for field: First Name

Last Name

You need to input a valid value for field: Last Name

Initial (optional)

Date of birth - (Year / Month / Day)

Sex

You need to input a valid value for field: Sex

Street

You need to input a valid value for field: Street

City

You need to input a valid value for field: City

Province

You need to input a valid value for field: Province

Postal Code

You need to input a valid value for field: Postal Code

Phone Number

You need to input a valid value for field: Phone Number

You need to input a valid value for field: Email

Campus

You need to input a valid value for field: Campus

Name of Program

You need to input a valid value for field: Name of Program

Coverage for

You need to input a valid value for field: Coverage

First Name

You need to input a valid value for field: First Name

Last Name

You need to input a valid value for field: Last Name

Date of birth - (Year / Month / Day)

You cannot add a child older than 25 years old :

You cannot choose a date of birth in the future :

Relationship

Sex

You need to select a valid value for field: Sex

Dependent school start date - (Year / Month / Day)

Start Date cannot be after End Date:

Dependent school end date - (Year / Month / Day)

End Date cannot be before Start Date:

Dependent's accredited school name

You need to input a valid value for field: School Name

Digital signature

You need to input a valid value for field: Signature

The Next button will be enabled once all informations about your dependents is complete.

Choose an option

	Option	Price
	{{lakeheadCustomizePartTimeName(title)}}	${{price}}

Please wait while your payment is registered.

The payment failed. Please try again in a few minutes.
If the problem persists, you can contact us via email or live chat support.

Sorry this Opt-In session is over.

Confirmation #{{optinModal.confirmationNumber}}

That is it!

Your Opt-In details will be emailed to you shortly.

Print Confirmation

Thanks for Speaking Up!

Opt-Out

Please select your program

You need to input a valid value for field: School

Please only list the last 9 digits of your student ID number Last 7 digits of your Student Number Please enter your Student ID number

You need to input a valid value for field: Student ID number

Reason for opting out:

You need to input a valid value for field: Reason

Please specify an opt-out reason

You need to input a valid value for field: Other Reason

I Agree

This Student ID has already Opt-Out for this session.
You will be able to Opt-Out again after this date: {{optoutModal.expiryDate}}

Campus

Program

You need to input a valid value for field: Program

Year of Study

You need to input a valid value for field: Year of Study

First Name

You need to input a valid value for field: First Name

Last Name

You need to input a valid value for field: Last Name

Date of birth - (Year / Month / Day)

Sex

You need to input a valid value for field: Sex

Address

You need to input a valid value for field: Address

City

You need to input a valid value for field: City

Province

You need to input a valid value for field: Province

Postal Code

You need to input a valid value for field: Postal Code

Phone

You need to input a valid value for field: Phone

You need to input a valid value for field: Email

I wish to opt out of

Attention: Band Sponsored Students
Please Note: If your band requires you to opt-out of the Student Health Plan, the refund will be refunded/mailed to the band directly.

If your Band has agreed to pay your Full tuition fees please check here

Band Name

You need to input a valid value for field: Band Name

Band Address

You need to input a valid value for field: Band Address

Band City

You need to input a valid value for field: Band City

Band Postal Code

You need to input a valid value for field: Band Postal Code

Band Province

You need to input a valid value for field: Band Province

Proof of required coverage:

Insurer (Name of Insurance Company)

Policy Number (Can be Group # or Contract #)

Primary Subscriber (Name of Insured Parent/Spouse/Self)

The Next button will be enabled once all proofs are complete.

If you wish to make alternative arrangements for your opt-out payment other than the direct deposit method, please contact the Katie Rizea of the SRC at krizea01@stclaircollege.ca before the opt-out deadline.

Refund Method

Account Holder (must be the students name and account)

You need to input a valid value for field: Account Holder

Transit Number (5 digits. Where can I find this number?)

You need to input a valid value for field: Transit Number

Institution (3 digits. Where can I find this number?)

You need to input a valid value for field: Institution

Account Number (Where can I find this number?)

You need to input a valid value for field: Account Number

You are about to opt-out of your benefit coverage.
This means your coverage you selected to opt out of will terminate and you will not be able to make claims. This action cannot be reversed nor can you opt out later for an additional benefit or change the benefit you are opting out of.

Student ID number	{{optoutModal.data.studentNumber}}
Campus	{{optoutModal.data.campus}}
Program	{{optoutModal.data.program}}
Year of Study	{{optoutModal.data.year}}
First Name	{{optoutModal.data.firstName}}
Last Name	{{optoutModal.data.lastName}}
Address	{{optoutModal.data.street}}
City	{{optoutModal.data.city}}
Province	{{optoutModal.data.state}}
Postal Code	{{optoutModal.data.zip}}
Date of Birth	{{optoutModal.data.birth \| date: 'yyyy-MM-dd'}}
Sex	{{optoutModal.data.gender \| ucfirst}}
Phone	{{optoutModal.data.phone}}
Email	{{optoutModal.data.email}}
Opt Out of	{{optoutModal.data.target}}
Refund Method	Cheque Direct Deposit Refund will be credited to the student account	Band ({{optoutModal.data.band.name}})

If you wish to proceed with opting out of your benefit coverage, press Confirm. If you want to change details, press Previous.
If not, press Cancel.

Please wait while your Opt-Out is registered.

Confirmation #{{optoutModal.confirmationNumber}}

That is it!

Your Opt-Out details will be emailed to you shortly. Print Confirmation

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	Current plan, no selection required

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MORE INFO

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Black Out Period Information

Please note that there is a black out period for fall semester 2018 from September 1st to October 12th, 2018. This allows administration time to ensure all students on the plan are registered as full-time students. IGNITE's Flexible Health and Dental plan is retroactive to September 1st, 2018 and all claims submitted during the blackout will be reviewed and processed beginning October 13th, 2018.

Flex Plan

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Thanks for Speaking Up!

Part Time Student Opt-In

Family Opt-In

Student information

Dependents information

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That is it!

Thanks for Speaking Up!

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Black Out Period Information