Opt-Out

If you are an eligible student and have comparable health and dental coverage you may apply to waive your student benefits. Each student is given one opportunity to waive benefits under the health and/or dental plan(s) each year. All waiver forms must be completed no later than 30 days after the start of your program. Approval of your opt out will result in the plan fee being credited.

There will be no exceptions or extensions for students who fail to submit their completed waiver prior to the applicable deadline. Should you miss the opt out deadline you are responsible for payment of the plan fees.

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 prior to any applicable deadlines.

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


Student Information

Student ID Number
Email Address
Confirm Email Address
First Name
Last Name
Gender
Date of Birth
Mailing Address
City
Province
Postal Code
Phone Number
Campus
Program Name
Program Start Date

Waive the Student Benefits Health Plan?

Required Information About the Extended Health Insurance You Have Now

Insurance Company
Policy Number
Your Relationship to the Plan Member of the Extended Health Insurance you have now:

Waive the Student Benefits Dental Plan?

Required Information About the Dental Insurance You Have Now

Insurance Company
Policy Number
Your Relationship to the Plan Member of the Dental Insurance you have now:



Once your waiver is processed, as long as you remain an eligible student, the benefits will automatically be waived each consecutive school year.

Should you have any questions regarding the waiver process please contact the RRCSA Student Benefits Plan Office prior to submitting this form.



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