CCSS - 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, government, 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, government, 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 and returning students:

If your program starts on September 6^th, you may submit an online application before October 5^th. If you miss the deadline, your next opportunity to Opt-Out would be next September.

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 and well-being?
Does my existing coverage meet all my needs?
The only time you can get back on this student plan is at the anniversary of starting your program (every year) OR within 30 days of losing your comparable coverage.

Proof of Comparable Coverage

You are required to provide proof of your comparable extended health and dental coverage by attaching documentation displaying the policy information when you are completing the online form.

Confirmation of coverage must show the name of the insurance company providing the coverage and the policy number. Acceptable forms of confirmation of coverage are:

Copy of a Plan Card (front and back images).
Confirmation letter from the employer or insurance company with a current date.
Recent health care claim statement with the current date (within 3 months of application submission).
Webpage printout with a visible current date.

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.
BC Medical Services Plan (MSP) 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, government, 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 within 4 years.
If a student previously opted out, within the past four (4) years they will not need to complete a new opt-out request as their status normally carries forward for four (4) years unless a student turns 25. A student's opt-out status will end on their 25^th birthday unless evidence of their continued enrollment in an extended health and/or dental plan is provided to ccssplan@camosun.ca for Lansdowne Campus students or interurbanplan@camosun.ca for Interurban Campus students.
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 submit the opt-out form, you will receive an automated confirmation email. Once an opt-out application has been approved, you will receive a second email with the status of your application. If you do not receive the confirmation, it is your responsibility to contact the Health and Dental officer for assistance within the 30-day opt-out period.
Please keep the confirmation 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.

7 Application status

You will receive an email with the status of your application within 5 business days.

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

Questions? Please contact your Benefit Plan Office: ccssplan@camosun.ca for Lansdowne Campus students or interurbanplan@camosun.ca for Interurban Campus students.

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

Campus

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 #

Online Forms Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications within 30 days from the start date of your program.

Plan Card Registration Form
Register for your Plan Card and use it where direct billing to Canada Life is available.

Prescription Search Tool
Find out if your prescription drugs are covered by the student plan.

Plan Claims
Learn more about submitting online or manual claims to Canada Life to get your refund.

Lansdowne Campus

Email: ccssplan@camosun.ca
Phone: 250-370-3696
Address: 3100 Foul Bay Rd
Victoria, BC. V8P 5J2

Interurban Campus

Email: interurbanplan@camosun.ca
Phone: 250-370-3869
Address: 4461 Interurban Rd
Victoria, BC. V9E 2C1

General Inquiries Line

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

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

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