URSU - Opt Out Form

Group number: 177841
Certificate Number: Student ID
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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 30^th, 2024

Make sure to submit your form by September 30^nd as the online form won't be accessible after that date. There is no opt-out form available during the winter term.

Opt-Out Eligibility

Students enrolled in the Student Health and Dental Plan may opt out of the plan during the fall term if they have comparable Health and Dental coverage from their parents, spouse, government, job, or band.

How to Opt Out

To Opt Out, you must be enrolled in the Student Benefits Plan, meet the Opt-Out eligibility criteria, and complete the online form before the applicable fall deadline.

Steps to Opt-Out

Things to consider when thinking of opting out:

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.

Important notes:

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.
Students must choose between annual or permanent opt-out.
Annual opt-outs: remain in force if students remain eligible for the plan for an academic year from September 1^st to August 31^st. If students wish to opt out of the benefits for the next academic year, they must apply again in the fall term.
Permanent opt-outs: remain in force if students remain eligible for the plan. Students do not need to apply to opt out again every academic year. Students will be charged the Health and Dental Plan fees and will be credited automatically.
Approval of your opt-out will result in the plan fee being credited.
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.

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

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

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 or Opt-In applications by September 30^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: uofregina@mystudentplan.ca
Phone: 587-811-0182
Address: Room 221, 3737 Wascana Parkway, Riddell Centre.
Regina, Saskatchewan S4S 0A2, CA

General Inquiries Line

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