FSU | Co-op Health Plan

Co-Op Health Plan (Domestic) Fall 2024

The price of the co-op health plan is $237.00.

This form will enable you to apply for the FSU Health Plan for the academic year by filling in the corresponding application section below.

This form must be completed by September 16, 2024 at 4:00 p.m.

(Coverage is September 1, 2024 through August 31, 2025)

Last Name: *

First Name: *

Middle Initial: *

Student Number: *

Date of birth: *

Gender: * Male Female

Program: *

Phone Number: *

Date: *

FOL email address: *

Opt-in

PLEASE ENROLL ME IN THE FOLLOWING:

(to be eligible, all students must have current OHIP or equivalent coverage)

Fall Deadline: September 16, 2024 at 4:00 p.m.

I wish to apply for: * $237.00 HEALTH BENEFITS (indicate by checkmark) (tax included)

(Pick one of the plan options below): * Balanced Plan Enhanced Dental Plan Enhanced Drug/EHC Plan

I wish to apply for the Fanshawe Student Union Health Plan and agree to be bound by the benefit plan terms and conditions.

Payment: After your form is processed, you will receive an email from ‘The Fanshawe Student Union’ to process your payment securely online through TD Merchant.

Signature: * Type your name in the field above

After presssing submit, it may take approximately 5 seconds before you are redirected to the next screen. Please do NOT press submit a second time.

Co-Op Health Plan

Co-Op Health Plan (Domestic) Fall 2024

Important Dates - Fall

Health Plan Documents

Mail-in Claim Forms

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Hours of Operation

Co-Op Health Plan

Co-Op Health Plan (Domestic) Fall 2024

Important Dates - Fall

Health Plan Documents

Mail-in Claim Forms

Quick Links

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Quick Menu

Get in Touch

Hours of Operation