Change the status of your Health and Dental Plan

Make changes to the status of your Health and Dental Plan (including adding or deleting dependents from your plan).

Use the Active Employees Benefits Change Request Form to add or delete eligible dependents from your plan.

You need this form to:

change the coverage to or from family coverage to single coverage
add or remove an eligible spouse or dependent
cancel your optional employee, spousal or child life insurance

Who can use this form

Eligible employees of the Government of Nova Scotia and participating member employers who are enrolled in the Health and Dental Plan can make changes to the status of their plan.

Eligible employees include:

civil service employees (excluding seasonal employees who work less than 6 months, casual and temporary relief employees and all other temporary employees)
Order in Council and ministerial appointees
members of the Executive Council
Members of the Legislative Assembly
members of NSGEU Civil Service Bargaining Unit Employees
members of the Canadian Union of Public Employees, Local 1867 – Nova Scotia Highway Worker’s Union

What you need to do

Complete the form.
Send your completed form by email, mail or fax.

How long it takes

Changes to your coverage are effective from the date the Benefits Unit receives your request. It should take Medavie Blue Cross 3 to 4 days to update your coverage. You’ll receive a new Blue Cross identification card at your home address 2 to 3 weeks from the date you submitted your request. It can take longer if more information is needed or if your form hasn’t been filled in correctly.

Cost

There is no cost to complete the form, but there are premiums associated with participating in the group health and dental plan.

Before you start

Make sure you have you employee identification number.

Download form

Active Employees Benefits Change Request Form (PDF 269 kB)

Other ways to submit the form

You can use the Active Employees Benefits Change Request Form to request to add or delete eligible dependents through Employee Self Service (ESS). If you’d like to receive a paper application by mail, contact the Benefits Unit.