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Opt-Out Form

PLEASE NOTE: THIS IS THE OPT-OUT FORM FOR RED RIVER COLLEGE STUDENTS ONLY! IF YOU DO NOT ATTEND ​RED RIVER COLLEGE PLEASE CLICK HERE TO SELECT YOUR SCHOOL.

Already have coverage?

Coordinating multiple plans: If you are an eligible student and have comparable coverage you may wish to coordinate your plans. Benefits under the two plans can be coordinated to increase your coverage up to 100% of the actual expense(s) incurred. For example, following payment under this plan you can submit outstanding balances to the other plan for consideration.

Opting Out of coverage: If you are an eligible student and have comparable health and/or dental coverage you may apply to opt-out of the plan(s). Each student is given one opportunity to opt-out of the health and/or dental plan(s) each year. All opt-out forms must be completed online and must be received within 30 days from the start date of your full-time program. You will not be able to opt-out of coverage at any other point during the school year.

NO EXCEPTIONS will be made if the deadline is missed. It is the student's responsibility to pay the plan fees, should they miss the applicable opt-out deadline.

Approval of your opt-out will result in the plan fee being credited. Once your opt-out has been accepted, it will remain in force as long as you remain an eligible student.

If you are unsure about whether or not you are eligible for the Student Health and Dental plan, please contact the RRCSA Student Benefits Plan Office within 30 days of the start date of your program.

Please read and agree to the Terms & Conditions prior to submitting your online opt-out.



Student Information

Date of Birth
Phone Number
Program Start Date

Service Members


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