Dental Opt-Out Applications

The health plan is mandatory; there is no opt-out form for the health plan. This form only applies to the dental plan.

Fall Application Period

August 1st to September 19th, 2026

Fall Academic Enrollment

Every student in an eligible program who has not previously opted out of the plan is charged the plan fee(s), and eligible to opt out by the specified fall deadline.

If this deadline is missed, you will be eligible to opt out next fall by the specified deadline as a returning student.

If you leave the school for more than a year you are considered a new student for the purposes of this form.

Winter Academic Enrollment

Only new students starting in the winter term who have been charged the plan fee(s) are eligible to opt out by the specified winter deadline.

If this deadline is missed, you will be eligible to opt out next fall by the specified deadline as a returning student.

If you leave the school for more than a year you are considered a new student for the purposes of this form.

things-to-considerThings to Consider
  1. You must be assessed the Dental Insurance Fee on your student account in order to opt out.
  2. You must provide Alternative Proof of Coverage through any of the following: your parents, spouse or common law partner, job, government, or band.
  3. 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.
  4. You can coordinate two benefit plans to maximize your coverage, potentially reaching up to 100% coverage! Find out more Coordination of Benefits.
  5. The Student Health Plan is mandatory. Therefore, there is no Health Plan Opt-Out.
  6. If you opt out of the dental plan, you are still considered to have access to dental insurance, which makes you ineligible for the Canadian Dental Care Plan (CDCP).
  7. Approval of the Student Dental Opt-Out application will result in the plan fee being refunded to the bank account you indicated on your form approximately 10 weeks from the start of the semester.
  8. 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.

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

Date of Birth
Phone Number
Program Start Date

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

Questions? Please contact your Benefit Plan Office: guelphplan@mystudentplan.ca