Students' Union, UCalgary - Opt-Out Form

Group number: 330753
Certificate Number: Student ID
FAQ
Call Centre: 1-866-586-1010
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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^st, 2024 to September 20^th, 2024

Make sure to submit your form by September 20^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, have proof of coverage, 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: uofcalgaryplan@mystudentplan.ca

The spring opt-out deadline is closed.

The spring deadline to apply was May 14^th, 2024. The online Opt-Out Form is not available at this time. The online form was open from April 14^th, 2024, until May 24^th, 2024.

NO EXCEPTIONS will be made if the deadline is missed.

If you were eligible for the plan for the first time in the winter or spring term and missed the deadline, your next opportunity to apply should be the winter or spring 2025 term respectively.

The online form will be open for new students and returning students meeting their program anniversary in the summer term on June 3^rd, 2024, and the deadline to apply is July 3^rd, 2024.

Eligibility Confirmation

Confirm your eligibility to opt out of the Student Benefits Plan by completing the following questions.

Are you a new student who has been assessed the Students' Union Health and Dental Plan fees on your student account?

You can only be assessed the Student Benefits Plan fees if you meet the plan eligibility criteria. Check the Student Benefits Plan Eligibility Criteria.

Yes

No

Are you a returning student on the anniversary of your enrollment in the Student Benefits Plan, who has been assessed the Students' Union Health and Dental Plan fees on your student account?

The anniversary refers to when you first became eligible for the Student Benefits Plan and were assessed the fees. For instance, if you were first eligible for the Student Benefits Plan in the winter term, your anniversary would happen every winter term.

Yes

No

Have you ever opted out of the Student Benefits Plan?

Yes

No

Are you covered by a comparable Health and Dental Plan from parents, spouse, work, government, or band?

The Alberta Health Care Insurance Plan (AHCIP), an International Emergency Plan, or the Student Benefits Plan are not acceptable as comparable insurance coverage.

Yes

No

You meet the eligibility criteria to opt out of the plan at this time.

The deadline to submit your health and dental opt-out application is June 3^rd, 2024. After the deadline, the online form will not be available.

Complete the online form below to submit your application. Completing the questionnaire does not mean that your application is approved, the Student Benefits Plan Office will confirm your eligibility and process your application.

You must provide documentation such as a scan/picture of your plan card, a confirmation letter from the employer of the insurance company, or a screenshot of your account on the insurance website when you are completing the online form. The documentation must show the name of the insurance company, the policy number, the student's name, and the current date.

Opting out of the health and dental plans is a one-time process. This means students do not need to apply every term or year. Once approved, the opt-out remains active on your account and you will not be assessed the health and dental fees.

The only time you can get back on this Student Benefits Plan is on the anniversary of opting out (every year) OR within 30 days ithin 30 days of the loss of your comparable coverage.

You may receive an email to advise that the opt-out application is being audited - as per the Terms and Conditions associated with the Opt-out of the Health and Dental Plan.

Once you submit 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.

It appears you do not meet the criteria to opt out at this time.

Only new students or returning eligible students registered on the anniversary of enrollment in the Student Benefits Plan, attending an applicable UCalgary's Undergraduate program as having full-time status, are automatically enrolled in the Health and Dental Plan and may apply to opt out.

If you have not been assessed the Students' Union Health and Dental Plan fees on your student account, you are either not eligible for the Student Benefits Plan or currently have an active opt-out on file.

The Students' Union Health and Dental Plan fees are mandatory and must be paid as well as the tuition total charges by the applicable deadline to avoid overdue penalties.

The next opportunity to submit your online application would be on the anniversary of your enrollment in the Student Benefits Plan.

If you have any questions, please initiate a chat by clicking on the right-bottom corner icon or contact the Benefits Plan Office by email at uofcalgaryplan@mystudentplan.ca or by phone at 403-220-3906.

It appears you do not meet the criteria to opt out at this time.

Only eligible students who are covered by a comparable Health and Dental Plan from parents, spouse, work, government, or band may apply to opt out.

The Dental Fee and Health Plan Fee are mandatory and must be paid as well as the Tuition total charges by the applicable deadline to avoid overdue penalties.

If you have any questions, please initiate a chat by clicking on the right-bottom corner icon or contact the Benefits Plan Office by email at uofcalgaryplan@mystudentplan.ca or by phone at 403-220-3906.

It appears you do not meet the criteria to opt out at this time.

Opting out of the health and dental plans is a one-time process. This means students do not need to apply every term or year. Once approved, the opt-out remains active on your account and you will not be assessed the health and dental fees.

If you have any questions, please initiate a chat by clicking on the right-bottom corner icon or contact the Benefits Plan Office by email at uofcalgaryplan@mystudentplan.ca or by phone at 403-220-3906.

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 20^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.

Benefits Plan Office

Email: uofcalgaryplan@mystudentplan.ca
Phone: 403-220-3906
Address: MSC 352, 2500 University Drive NW.
Calgary, Alberta T2N 1N4, CA

General Inquiries Line

Monday to Friday
from 6:00am to 5:00pm MST
Phone: 1-866-586-1010

Opt-Out Applications

Fall Application Period

Opt-Out Eligibility

How to Opt Out

The spring opt-out deadline is closed.

Eligibility Confirmation

Are you a new student who has been assessed the Students' Union Health and Dental Plan fees on your student account?

Are you a returning student on the anniversary of your enrollment in the Student Benefits Plan, who has been assessed the Students' Union Health and Dental Plan fees on your student account?

Have you ever opted out of the Student Benefits Plan?

Are you covered by a comparable Health and Dental Plan from parents, spouse, work, government, or band?

Health and Dental Opt-Out Form

Student Information

Required Direct Deposit Information

Benefits Plan Office

General Inquiries Line

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