SAMU - 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 Opt Out of your Student Benefits Plan

Fall term - September 30^th, 2024

After the deadline, the online form will not be available.

Opt-Out Eligibility

There are 2 circumstances in which students enrolled in the Student Health and Dental Plan may opt out: (1) when they are starting the fall term, or (2) when they are new students in winter term.

Out-Out Eligibility

How to Opt Out

To Opt Out, you must be enrolled in the Student Beneftis Plan, meet the Opt-Out eligibility criteria, and complete the online form before the applicable term deadline.

Steps to Opt-Out

Things to consider:

A parents' insurance plan ceases coverage until you turn either 18 or 21, or up to 25 if you are studying full-time at a recognized education institution.
You can combine two benefit plans to maximize your coverage, potentially reaching up to 100% coverage! Find out more Coordination of Benefits.
Students with comparable coverage can choose to opt out of the health, dental, or both plans.
Approval of the Student Benefits Plan Opt-Out application will result in the plan fee being refunded according to the school's policy.
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.

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

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

The winter opt-out deadline is closed.

The winter deadline to apply was January 31^st, 2024. The online Opt-Out Form is not available at this time. The online form was open from December 1^st, 2023, until January 31^st, 2024.

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.

If you were eligible for the plan for the first time in the winter or fall term and missed the deadline, your next opportunity to apply should be the fall 2024 term.

The online form will be open for all eligible students in the fall term on August 1^st, 2024, and the deadline to apply is September 30^th, 2024.

Health and Dental Opt-Out Form

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 #

Online Forms Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by January 31^st, 2024

Plan Card Generator
Generate 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.

SAMU Benefits Plan Office

Email: macewanplan@mystudentplan.ca
Phone: 780-497-4675
Address: 10850 - 104 Avenue NW
SAMU Building - SA-109A
Edmonton, AB. T5H 0S5

General Inquiries Line

Monday to Friday from 6:00am to 5:00pm MST

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

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Online Forms

Health and Dental Opt-Out Application

Deadline to Opt Out of your Student Benefits Plan

Opt-Out Eligibility

How to Opt Out

The winter opt-out deadline is closed.

Eligibility Confirmation

Are you a new winter student who has been assessed the Health Insurance Fee and the Dental Insurance Fee on your student account?

Have you been assessed the Health Insurance Fee and the Dental Insurance Fee on your student account?

Are you a returning student who has not attended the fall term and has been assessed the Health Insurance Fee and the Dental Insurance Fee on your student account?