SAMRU - Opt-Out Form

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.

Online Forms

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.

Opt-Out Applications

Submit your health and/or dental opt-out application before the deadline.

Fall Application Period

August 1^st, 2024 to September 27^th, 2024

Make sure to submit your form by September 27^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 starting the fall term or (2) when they are new students in winter term.

Out-Out Eligibility

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

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: mtroyalplan@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

Fall Deadline
Submit your online Family Add-On, Opt-Out, or Opt-In applications by September 27^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.

SAMRU Benefits Plan Office

Email: mtroyalplan@mystudentplan.ca
Phone: 403-440-6267
Address: Room Z001, Wyckham House
4825 Mount Royal Gate SW
4500-50 Street
Calgary, Alberta. T3E 6K6

General Inquiries Line

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

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

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