Opt-Out Form | Gallivan

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 re-enrolled? Eligible Students may submit their online forms.

Health and Dental Opt-Out

Deadline to submit applications

Students starting in September must submit the opt-out form by October 5^th. Students starting in January must submit the opt-out form by February 5^th. Students starting their program at any other time of year, the deadline to complete an opt-out form is 30 days from their program start date.

This is an annual opt-out. All students who choose to, and are eligible to waive the Health & Dental Plan each year they are an eligible student at NSCC, must submit the opt-out form upon the anniversary of their original program start date.

If you opted out but withdrew from NSCC and are now returning to study in the same academic year, you may not be required to resubmit your opt-out form. Contact the Student Benefits Office to see if your previously submitted opt-out form remains valid or if a new opt-out must be submitted.

Eligibility Criteria

All new and returning students who are automatically enrolled in the Health & Dental Plan can choose to opt-out of the plans if they have comparable coverage through their parents, spouse, government program, employer, or band.

Students starting in September must submit the opt-out form by October 5^th. Students starting in January must submit the opt-out form by February 5^th. All other students have 30 days from their program start date to submit their opt-out form.

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 at the Coordination of Benefits section.
What is in the best interest of my overall health & wellbeing?
Does my existing coverage meet all my needs?
The only time you can get back on this student plan is at the start of next year OR within 30 days of losing your alternate coverage.

Important notes:

Nova Scotia Provincial Health Care, Nova Scotia Pharmacare or the NSCC Student Plan is not acceptable as comparable insurance coverage.
If you are a student sponsored by the Department of Community Services, you will be automatically opted out from the Student Benefit Plan.
First Nations and Indigenous students who do not have a policy number, please provide your Band Name and Number when you are completing the information about the insurance company and policy number.
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 student's opt-out will result in the plan fee being credited 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.
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 your Health and Dental Opt-Out:

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 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.

5 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: nsccplan@mystudentplan.ca

Health and Dental Opt-Out Form

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 #

Enrolment Options
Add Family, Opt-in, and Opt-out
Deadline: 30 days from the start date of your program

International Opt Out
Opt out with your MSI Card today.

Health & Dental myBenefits Card Generator
Generate your benefit Card today.

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