CSA - Opt-Out Form

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Student Health & Wellness!mystudentplan is a benefits plan for students and can provide coverage for prescription drugs, vision care, dental care, mental health counseling, and more. The plan is designed to supplement provincial health insurance and provide additional access to medical services.

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Are you covered by a comparable plan? Do you wish to cover your dependents? Or have you opted out of the plan and wish to be re-enrolled? Eligible Students may submit their online forms.

Health and Dental Opt-Out Application

Deadline to Opt Out of your Student Benefits Plan

Spring-Summer term - May 20^th, 2024

After the deadline, the online form will not be available.

Opt-Out Eligibility

There are 3 circumstances in which students enrolled in the Student Health and Dental Plan may opt out: (1) when they are starting the fall term, (2) when they are new students in winter term or or (3) when they are new students in Spring-Summer term.

Out-Out Eligibility

Eligibility Criteria to Opt Out of the Student Benefits Plan

All eligible students taking a minimum of one MacEwan University credit level course are automatically enrolled in the Balanced Health and Dental plans. Students get one opportunity per academic year to opt out and must meet the following criteria in order to have their application approved:

1 Fall Academic Enrollment

All eligible students attending the fall term; and
Assessed the CSA Health and Dental Plan Fees on their student account; and
Must be covered by alternate comparable Health and dental coverage from their parents, spouse, job, government or band; and
Must submit their opt out application before the applicable fall deadline.

Eligible students who miss the fall deadline would be able to opt out the following fall term if they are fall-enrolled students. Students will not be able to opt out in the winter term.

2 Winter Academic Enrollment

New eligible winter students; and
Assessed the CSA Health and Dental Plan Fees on their student account; and
Must be covered by alternate comparable Health and dental coverage from their parents, spouse, job, government or band; and
Must submit their opt out application before the applicable winter deadline.

New eligible winter students who miss the winter deadline would be able to opt out the following fall term if they are fall-enrolled students.

3 Spring-Summer Academic Enrollment

New eligible spring-summer students; and
Assessed the CSA Health and Dental Plan Fees on their student account; and
Must be covered by alternate comparable Health and dental coverage from their parents, spouse, job, government or band; and
Must submit their opt out application before the applicable winter deadline.

New eligible spring-summer students who miss the spring-summer deadline would be able to opt out the following fall term if they are fall-enrolled students.

How to Opt Out

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

Steps to Opt-Out

Steps to Opt-Out of the Student Health and Dental Plan

The following are the steps to submit a mystudentplan Opt-Out Application:

1 Confirm Eligibility

Complete the questions to confirm whether or not you are eligible to opt out at this time.

2 Student Information

Accurately complete all fields on the student information section. Click NEXT.

3 Health Plan Opt-Out

Check yes/no to opting out of the health portion of the Student Benefits Plan and provide alternate insurance details. Click NEXT.

4 Dental Plan Opt-Out

Check yes/no to opting out of the dental portion of the Student Benefits Plan and provide alternate insurance details. Click NEXT.

5 Read and Agree to the Terms and Conditions

Click on the checkbox to confirm you have read and agree to the Terms and Conditions agreement. Click SUBMIT to finish your application.

6 Confirmation Email

Check your email to confirm you have received your confirmation email. Keep this email as its your only proof of applying to opt out. If you do not receive this email confirmation, contact the Benefits Plan Office before the deadline.

7 Application Status

You will receive an email with the status of your application.

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: concordiaplan@mystudentplan.ca

The winter opt-out deadline is closed.

The winter deadline to apply was January 20^th, 2023. The online Opt-Out Form is not available at this time. The online form was open from December 1^st, 2023, until January 20^th, 2024.

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.

If you were eligible for the plan for the first time in the winter or fall term and missed the deadline, your next opportunity to apply should be the fall 2024 term.

The online form will be open for only new eligible spring-summer students on April 1^st, 2024, and the deadline to apply is May 20^th, 2024.

Eligibility Confirmation

Confirm your eligibility to opt out of the CSA Health and/or Dental Plans by completing the following questions.

Have you been assessed the CSA Health and Dental Plan Fees on your student account?

You can only be assessed the CSA Health and Dental Plan Fees if you meet the plan eligibility criteria. Check the Student Benefits Plan Eligibility Criteria.

Yes

Are you a new winter student who has been assessed the CSA Health and Dental Plan Fees on your student account?

You can only be assessed the CSA Health and Dental Plan Fees if you meet the plan eligibility criteria. Check the Student Benefits Plan Eligibility Criteria.

Yes

Are you a new spring-summer student who has been assessed the CSA Health and Dental Plan Fees on your student account?

You can only be assessed the CSA Health and Dental Plan Fees if you meet the plan eligibility criteria. Check the Student Benefits Plan Eligibility Criteria.

Yes

Student Health and Dental Plan Enrollment

Eligibility Criteria to be automatically enrolled in the CSA Health and/or Dental plans.

All eligible domestic and international students studying for more than 12 months who meet the following criteria are automatically enrolled in the CSA Health and/or Dental plans.

Registered in an eligible program as having full-time status at the Concordia University of Edmonton; and
Members of the Concordia Students' Association - CSA; or
Members of the Graduate Students' Association (GSA) - International students only, studying more than 12 months; and
Residing in Canada studying in person or online; and
Under the age of 70.

Enrollment Confirmation

If you are not sure if you meet the eligibility criteria, please visit the Online Services at the University and log in using your account. If you see the Health and Dental Fees included in your tuition, you are covered by the Health and Dental Plan provided by the Students Association.

If you are unsure about whether or not you are eligible for the Student Health and Dental plans, please contact your Benefit Plan Office at concordiaplan@mystudentplan.ca before any applicable deadlines.

Have you ever opted out of the CSA Health and/or Dental Plans (both)?

Yes

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

The Alberta Health Care Insurance Plan (AHCIP), Student Health Plan (mycanadaplan), Repatriation Plan or the CSA Health and/or Dental Plans are not acceptable as comparable insurance coverage.

Yes

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

The deadline to submit your health and/or dental opt-out application is May 20^th, 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.

Opting out of the CSA health and/or 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 CSA Health and Dental Plan Fees.

The only time you can get back on this CSA health and/or dental plans is in the fall term (every year) OR within 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/or 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.

If you have not been assessed the CSA Health and Dental Plan Fees on your student account, you are either not eligible for the CSA Health and/or Dental plans or currently have an active opt-out on file.

All eligible domestic and international students studying for more than 12 months at the Concordia University of Edmonton are automatically enrolled in the Health and Dental Plan and may apply to opt out.

If you have any questions, please initiate a chat by clicking on the right-bottom corner icon or contact the Student Benefits Plan Office by email at concordiaplan@mystudentplan.ca or by phone at 1-877-746-5566 Extension 7239.

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

If you are not a new spring-summer student, you do not meet the eligibility to opt out.

If you are not a new winter student, you do not meet the eligibility to opt out.

The CSA Health and/or 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 opt-out application would be in the upcoming fall term.

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 CSA Health and/or Dental Plan Fees are mandatory and must be paid as well as the Tuition total charges by the applicable deadline to avoid overdue penalties.

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

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

* Required

Email Address

* RequiredInvalid Email

Confirm Email Address

* Emails Must Match * Required

First Name

* Required

Last Name

* Required

Date of Birth

Date Month Field Date Day Field Date Year Field

Mailing Address

* Required

City

* Required

Province

* Required

Postal Code

* Required

Phone Number

Phone Area Number Phone Local Number Phone Digits

* Required

Campus

Program Name

* Required

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 #

Transit # must be at least 5 digits long * Required

Institution #

Institution # must be at least 3 digits long * Required

Account #

Account # must be numeric * Required

Spring-Summer Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by May 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.

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CSA Benefits Plan Office

Email: concordiaplan@mystudentplan.ca
Phone: 1-877-746-5566 Extension 7239
Address: Concordia Students' Association
7128 Ada Blvd
Edmonton AB. T5B 4E4

General Inquiries Line

Monday to Friday from 6:00am to 5:00pm MST

Phone: 1-877-746-5566 Ext. 7249

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