OPT OUT HERE - BCFSNew

Student Information

Existing Coverage

Summary

Student Information

I confirm I am a student at Vancouver Community College

First Name

Last Name

Date of Birth

Phone Number

Student Number

Confirm Student Number

Confirm Email

Program Start Date

Program Type

Existing Coverage

My existing coverage is through

Name of Employer or plan sponsor providing coverage

Principal Person Covered

Health Coverage Provided by

Health Policy Number

Dental Coverage Provided by

Dental Policy Number

I confirm that I am opting out with equivalent coverage. Equivalent coverage does NOT include the Canadian Dental Care Plan (CDCP), BC Medical Services Plan (BC MSP) or an interim international student insurance plan (GuardMe, AwayCare, or alternate).

Summary

First Name
Last Name
Date of Birth
Phone
Student Number
Email
Program Start Date
Program Type
Covered Person
My existing coverage is through
Name of Employer or plan sponsor providing coverage
Health Coverage Provided by
Health Policy Number
Dental Coverage Provided by
Dental Policy Number