Submission of an online form indicates:

• an understanding that it is solely the responsibility of the student whose name and identification number (The Student) is on the form to ensure that the form has been received by the benefit office/representative;
• an understanding that the information provided is required in order fulfill the purpose of the form;
• authorization and consent to the use, release and exchange of said information between the educational institution, the student organization, the plan broker, third party service providers and the insurance company(s) to be used solely in connection with the administration of the Student Benefits Plan;
• confirmation that all the information provided is accurate; and
• that additional terms as indicated below by type of form also apply.
• an understanding that you cannot use their provincial coverage, equivalent to provincial plan coverage or OHIP + to opt out of the health and dental plan provided by your student organization or institution as it is not considered comparable coverage.

Falsification of any information provided by The Student is considered to be a serious form of fraud.

OPT-OUT FORM: The Student wishes to decline the student health and/or dental plan(s) coverage. Comparable health and/or dental coverage are presently provided for the student under another insurance plan. The Student understands that s/he would have been able to claim under his/her existing insurance as well as under the student health and/or dental plan(s), thereby increasing coverage.

The Student acknowledges that as a result of the opt-out, s/he forfeits all rights to coverage otherwise available to him/her under the student health and/or dental plan(s). The Student realizes that s/he will not be able to rejoin the plan(s) until the policy anniversary or unless s/he ceases to be covered by the insurance used to opt-out of the student health and/or dental plan(s) and apply within 30 days of losing said coverage. The Student must complete the necessary form, pay any fees associated in rejoining the plan(s) and proved the necessary proof of loss of insurance in order to reinstate coverage.

OPT-OUT DEADLINE: The opt-out deadline dates are established by the Institution or Student Organization. You will not be able to opt-out of coverage at any other point during the school year. For example, if your program starts in September, you must opt-out prior to the end of the Fall deadline. The same rule applies for opting in (unless you lose your comparable coverage, see below for loss of coverage information). NO EXCEPTIONS will be made if the deadline is missed. It is The Student's responsibility to pay the plan fees, should they miss the applicable opt-out deadline.

OPT-OUT EMAIL CONFIRMATION: You will receive a reply email confirmation after you complete and submit the online opt-out. Please retain a copy of the email confirmation for your records. The email confirmation is your ONLY proof that you applied to opt-out of the coverage. If you do not receive a confirmation email please contact the Member Services Office before the applicable deadline.

ONLINE OPT-OUT AUDIT: You may be asked to provide documentation of your existing coverage at any time throughout each year of coverage. Documentation must show the name of the insurance company providing coverage and the policy number.

Acceptable documentation may be:

• A screenshot of a summary of benefits from your insurance company’s website that clearly indicates you are covered for extended health, drug and dental.
• A copy of a certificate or card clearly indicating your coverage for extended health, drug and dental, the insurance company name and the policy/identification number.
• A letter from the plan sponsor (often the employer) or the insurance company confirming that you are covered under a supplemental health and dental plan.

Without such documentation you will be reinstated to the mandatory benefit plan and assessed the applicable fee.