Student Eligibility Form

If your dependent is 21+ and attending school full-time, they may still qualify for coverage. Submit a Student Enrollment Form with proof of enrolment, and we'll take care of the rest.

Beneplan Student Eligibility Form - Online (English) 

Beneplan Student Eligibility Form - Download/Print (English)

Beneplan Student Eligibility Form - Online (French)

Beneplan Student Eligibility Form - Download/Print (French)

If you have any questions please contact us at [e-mail]