Student Health and Wellness

Opt-Out Applications

Submit your virtual health care opt-out application before the deadline.

Fall Application Period

August 1^st to September 20^th, 2026

Make sure to submit your form by September 20^th as the online form won't be accessible after that date.

Important Notes:

The virtual health care opt-out is annual. You will be re-enrolled next year on your enrollment anniversary. If you wish to opt-out again, you will need to complete this form before the applicable deadline.
Students who opt-out of the virtual health care will lose access to vitual benefits.
Approval of the virtual health care opt-out will result in the CUESA Virtual Health Care fee being refunded according to the school's policy.
Once you opt-out of the virtual health care, you cannot re-enroll until your enrollment anniversary.
NO EXCEPTIONS will be made if the deadline is missed. Students are responsible for paying the plan's mandatory fees if they miss the opt-out deadline.
Upon completing the virtual health care 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.

The opt-out form is not accessible at this time.

The winter application period was from December 1^st, 2025 to January 20^th, 2026.

NO EXCEPTIONS are made if the deadline is missed. The student must pay the plan's mandatory fees should they miss the applicable opt-out deadline.

Fall 2026: Online applications will open on August 1^st, 2026, and the deadline is September 20^th, 2026. This deadline applies

Virtual Health Care Opt-Out Form

Please complete all information on the Virtual Health Care 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

Postal Code

Phone Number

Phone Area Number Phone Local Number Phone Digits

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 #

Transit # must be at least 5 digits long * Required

Institution #

Institution # must be at least 3 digits long * Required

Account #

Account # must be numeric * Required

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