Health and Dental Claim Forms

Health and Dental Claim Forms are available in the GSU Office, or can be downloaded from Green Shield's website.

Opt-in/Opt-out Forms

The opt-out and opt-in date for the current semester has already passed. The opt-out and opt-in date for Spring/Summer 2010 is May 31st, 2010.

1. Opt-In Form (.DOC format) (May 2010 - Aug 2010)

To add your family members to the plan, you must return this form with payment to the Graduate Students' Union (GSU) by May 31st, 2010.

2. Opt-Out Form (.DOC format) (Spring/Summer 2010)

Opt-Out Form, for students with existing spousal, parental or other health insurance coverage: You must return this completed form and documentation (i.e., proof of existing coverage) by May 31st, 2010 for the Spring/Summer 2010 semester to the Graduate Students’ Union in person or by fax. ***

Outline of Benefits 2008-2009

Outline of Benefits (.PDF format)

For members of the GSU health and dental insurance plan, this document from Green Shield details your insurance coverage and benefits for 2008-2009)

Health and Dental card

Health and Dental card (.PDF format)

For students on either/both the Health and Dental plans. Your card can also be obtained by contacting the GSU Office ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).