SARDP - Opt Out Form

Plan Number: 330757
Certificate Number: Student ID
FAQ
Canada Life: 1-800-957-9777
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Student Health and Wellness! mystudentplan provides health, prescriptions, dental, mental health care plus additional benefits for eligible students.

Opt-Out Applications

Submit your health and/or dental opt-out application before the deadline.

Fall Application Period

August 1^th, 2024 to September 15^th, 2024 at 4:00 pm

Make sure to submit your form by September 15^th as the online form won't be accessible after that date.

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 new students or (2) when they are returning students on the anniversary of enrolling in the Student Benefits Plan.

Opt-Out Eligibility

How to Opt Out

To Opt Out, you must be enrolled in the Student Benefits 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: sahealthplan@rdpolytech.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 #

Fall Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by September 15^th, 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.

Opt-Out Applications

Fall Application Period

Opt-Out Eligibility

How to Opt Out

Health and Dental Opt-Out Form

Student Information

Required Direct Deposit Information

Benefits Plan Office

General Inquiries Line

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