Adding your family

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BCITSA Student Health Plan

BCITSA Student Health Plan

BCITSA Student Health Plan

Adding Your Family to the BCITSA Student Health Plan

Adding Your Family to the BCITSA Student Health Plan

Adding Your Family to the BCITSA Student Health Plan

Health for 1 or more people: Dental for 1 person: Dental for 2 or more people:

$120/year $120/year $240/year

You can add your spouse and/or dependents onto the health plan by bringing in the following:

Health for 1 or more people: Dental for 1 person: Dental for 2 or more people:

$120/year $120/year $240/year

You can add your spouse and/or dependents onto the health plan by bringing in the following:

Health for 1 or more people: Dental for 1 person: Dental for 2 or more people:

$120/year $120/year $240/year

You can add your spouse and/or dependents onto the health plan by bringing in the following:

Your BCIT student ID or letter of acceptance

Your BCIT student ID or letter of acceptance

Your BCIT student ID or letter of acceptance

A certified cheque or money order for $______ payable to The BCIT Student Association. IMPORTANT: We DO NOT accept cash, credit cards, Debit, or personal cheques.

A certified cheque or money order for $______ payable to The BCIT Student Association. IMPORTANT: We DO NOT accept cash, credit cards, Debit, or personal cheques.

A certified cheque or money order for $______ payable to The BCIT Student Association. IMPORTANT: We DO NOT accept cash, credit cards, Debit, or personal cheques.

If your family was on another health plan and lost their coverage, bring PROOF of loss of coverage. You must come in within 30 days of coverage loss to add them to the plan.

If your family was on another health plan and lost their coverage, bring PROOF of loss of coverage. You must come in within 30 days of coverage loss to add them to the plan.

If your family was on another health plan and lost their coverage, bring PROOF of loss of coverage. You must come in within 30 days of coverage loss to add them to the plan.

IMPORTANT: you have 30 days from the start of your program every year to add family members.

IMPORTANT: you have 30 days from the start of your program every year to add family members.

IMPORTANT: you have 30 days from the start of your program every to add family members.

Family Add-On Deadline:___________________

Family Add-On Deadline:___________________

Family Add-On Deadline:___________________

P: 604-456-8056 F: 604-434-5726 E: healthplan@bcitsa.ca Location: SE2 Rm 286 www.bcitsa.ca

P: 604-456-8056 F: 604-434-5726 E: healthplan@bcitsa.ca Location: SE2 Rm 286 www.bcitsa.ca

P: 604-456-8056 F: 604-434-5726 E: healthplan@bcitsa.ca Location: SE2 Rm 286 www.bcitsa.ca


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