RRCSA - Opt-Out Form

Student Health & Wellness!mystudentplan is a benefits plan for students and can provide coverage for prescription drugs, vision care, dental care, mental health counseling, and more. The plan is designed to supplement provincial health insurance and provide additional access to medical services.

Online Forms

Are you covered by a comparable plan? Do you wish to cover your dependents? Or have you opted out of the plan and wish to be re-enrolled? Eligible Students may submit their online forms.

Health and Dental Opt-Out Application

Deadline to submit applications
30 days from the official start date of your program.

Only new students or returning students whose anniversary of enrollment is the current month may apply to opt out of the Student Health and Dental Plan before the deadline.

Eligibility Criteria

There are 2 circumstances for Opting Out of the Student Health and Dental Plan:

1 New Students

Students starting an eligible program and qualifying for the plan who have comparable Health and Dental coverage from their parents, spouse, job, or band may apply by the applicable deadline.

The deadline is 30 days from the official start date of your program.

2 Returning Students

Returning Students enrolled in their anniversary of starting an eligible program and qualify for the plan who have comparable Health and Dental coverage from their parents, spouse, job, or band may apply by the applicable deadline.

The deadline is 30 days from the anniversary of the official start date of your program.

Deadline example for new & returning students:

If your program starts on August 28^th, you may submit an online application before September 27^th. If you miss the deadline, your next opportunity to opt-out would be next August.

Things to consider when thinking of opting out:

A parents' insurance plan will stop covering you if you are a part-time student over the age of 21 or a full-time student over the age of 25.
You can coordinate 2 benefit plans and increase your coverage up to 100%! Find out more Coordination of Benefits
What is in the best interest of my overall health & wellbeing?
Does my existing coverage meet all of my needs?
The only time you can get back on this student plan is on the anniversary of opting out of the plan OR within 30 days of losing your alternate coverage.

Opt-Out Audit

If your application has been chosen for an audit, you may be asked by email to provide documentation of your existing coverage to confirm that you are already covered with comparable Health and Dental Plan. Please do not email any documentation to our offices until you receive an email request.

Important notes:

If you started your program in a different month than the current one, your request to opt out will not be approved at this time. Your next opportunity to opt out would be the next anniversary of the start date of your program.
Manitoba Health or The Student Plan is not acceptable as comparable insurance coverage.
Students with comparable coverage can choose to opt out of health, dental, or both.
The comparable coverage accepted could be from parents, spouse, work, or band.
Approval of the Students opt-out will result in the plan fee being refunded according to the school's policy. The Opt-Out result is a one-time process. This means students do not need to apply every term or year.
NO EXCEPTIONS will be made if the deadline is missed. It is the student's responsibility to pay the plan's mandatory fees, should they miss the applicable opt-out deadline.
Once you complete the opt-out form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting an opt-out request.

Steps to submitting a Health and Dental Opt-Out Application:

1 Student Information

Complete this section below providing true and correct information. Click NEXT.

2 Health Plan Opt-Out

Scroll down and check yes/no if you wish to opt-out of the health portion of the student plan. Provide the alternate insurance company name and policy number. Click NEXT.

3 Dental Plan Opt-Out

Scroll and check yes/no if you wish to opt out of the dental portion of the student plan. Provide the alternate insurance company name and policy number. Click NEXT.

4 Proof of coverage

Upload the proper proof of your comparable extended health coverage by attaching documentation displaying the policy information. Click NEXT.

5 Read and Agree to the Terms and Conditions

Click on the checkbox to indicate that you agree to the Terms and Conditions agreement. Click SUBMIT to finish your application.

6 Confirmation email

Check your email and verify if you have received the confirmation email.
If you do not receive this email, you must resubmit the form.

Add donotreply@gallivan.ca to your address book. Please do not reply to this email.

Questions? Please contact your Benefit Plan Office: redriverplan@mystudentplan.ca

Health and Dental Opt-Out Form

Please complete all information on the opt out form and we will process your application as soon as we can.

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

Date of Birth

Date Month Field Date Day Field Date Year Field

Mailing Address

City

Province

Postal Code

Phone Number

Phone Area Number Phone Local Number Phone Digits

Program Name

Program Start Date

Date Month Field Date Day Field Date Year Field

Required Direct Deposit Information

Please enter your financial institution's Transit Number, Institution Number, and Account Number. (*mandatory fields)

** Please do not enter any dashes or spaces **

Transit #

Institution #

Account #

Notre Dame Campus

Phone: 204-632-2503
Address: RRCSA Student Benefits Plan Office
Room CM75C
2055 Notre Dame Avenue
Winnipeg, Manitoba. R3H 0J9

Exchange District Campus

Phone: 204-949-8537
Address: The Roblin Centre
SA Office P-110
160 Princess Street
Winnipeg, Manitoba. R3B 1K9

Email: redriverplan@mystudentplan.ca

General Inquiries Line

Monday to Friday from 5:00am to 4:00pm PST

Phone: 1-877-746-5566 Ext. 7249

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