• GSA Carleton Health and Dental Opt In Form

    PLEASE READ CAREFULLY: This is a secure form for the purposes of opting in to health and dental coverage, or opting in your dependents. If you have not paid the GSA health and dental insurance fee through your Carleton Central account (the amount is $410.89, as can be seen in your fee statement), and you need to opt in dependents, you need to pay for the INDIVIDUAL coverage AND the appropriate DEPENDENT coverage. If you need any help navigating the form or understanding the choices, please email gsa@gsacarleton.ca for assistance. Please ensure you have flash enabled if you are using Google Chrome, otherwise your payment may not go through.
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  • Dependent Information (if applicable)

    Fill in your dependents here if you are applying additional coverage.
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    Individual or Student Coverage
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