SPSA - Opt-Out Form

Plan Number: 52446
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.

Health and Dental Opt-Out Application

Deadline to submit applications
30 days from the official start date of your program.

Only new students or returning students whose anniversary of enrollment is the current month may apply to opt out of the Student Health and Dental Plan before the deadline.

Eligibility Criteria

There are 2 circumstances for Opting Out of the Student Health and Dental Plan:

1 New Students

Students starting an eligible program and qualifying for the plan who have comparable Health and Dental coverage from their parents, spouse, government, job, or band may apply by the applicable deadline.

The deadline is 30 days from the official start date of your program.

2 Returning Students

Returning Students enrolled in their anniversary of starting an eligible program and qualify for the plan who have comparable Health and Dental coverage from their parents, spouse, government, job, or band may apply by the applicable deadline.

The deadline is 30 days from the anniversary of the official start date of your program.

Deadline example for new and returning students::

If your program starts on September 6^th, you may submit an online application before October 6^th. If you miss the deadline, your next opportunity to Opt-Out would be next September.

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 Coordination of Benefits
What is in the best interest of my overall health and well-being?
Does my existing coverage meet all my needs?
The only time you can get back on this student plan is at the anniversary of starting your program (every year) OR within 30 days of losing your comparable coverage.
mylegalplan - Legal coverage and myvirtualdoctor - virtual health care service are included as part of the health plan. If you opt-out of the health plan, you opt-out of these services. Learn more about your health plan details to make an informed decision.

Proof of Comparable Coverage

You are required to provide proof of your comparable extended health and dental coverage by attaching documentation displaying the policy information when you are completing the online form.

Confirmation of coverage must show the name of the insurance company providing the coverage and the policy number. Acceptable forms of confirmation of coverage are:

Copy of a Plan Card (front and back images).
Confirmation letter from the employer or insurance company with a current date.
Recent health care claim statement with the current date (within 3 months of application submission).
Webpage printout with a visible current date.

Important notes:

If you started your program in a different month than the current one, your request to opt out will not be approved at this time. Your next opportunity to opt out would be the next anniversary of the start date of your program.
Saskatchewan Health Services or The Student Plan is not acceptable as comparable insurance coverage.
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 Students opt-out will result in the plan fee being refunded according to the school's policy. The Opt-Out result is a one-time process. This means students do not need to apply every term or year.
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 a Health and Dental Opt-Out Application:

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 Proof of coverage

Upload the proper proof of your comparable extended health coverage by attaching documentation displaying the policy information. Click NEXT.

5 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.

6 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.

7 Application status

You will receive an email with the status of your application within 5 business days.

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

Questions? Please contact your Benefit Plan Office: spsahealth@spsa.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

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 #

Online Forms Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications within 30 days from the start date of your program.

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.

Benefits Plan Office

Email: spsahealth@spsa.ca

Moose Jaw Campus
Phone: 306-691-8515
Address: Room 1. 202
600 Saskatchewan St. W
Moose Jaw, SK. S6H 4R4

Prince Albert Campus
Phone: 306-765-1709
Address: Room F 206 Student Lounge Tech Centre 1100-15th St. E
Prince Albert, SK. S6V 7S4

Regina Campus
Phone: 306-775-7820
Address: Room 145
4500 Wascana Pkwy
Regina, SK. S4P 3A3

Saskatoon Campus
Phone: 306-659-4458
Address: Room 119
1130 Idylwyld Dr. N
Saskatoon SK. S7K 3R5

General Inquiries Line

Monday to Friday
from 6:00am to 5:00pm CST
Phone: 1-877-746-5566