UHIP Cancellation Form

Source: https://dnn.uottawa.ca/en/Utilities/Multiform/IO/UHIP-Cancellation-Form Parent: https://www.uottawa.ca/study/international-students/university-health-insurance-plan-uhip

General Comment

This form is to be used by international students who have coverage under a UHIP Pre-Approved Health Care Plan.

Please note that this form is NOT to be used if you wish to opt out of the Health and Dental Insurance plans.

To request to opt out of the Health and Dental Insurance, please contact the uOttawa Student’s Union (UOSU) if you are an undergraduate or the Graduate Student Association (GSAED) if you are a graduate student.

Finally, if you are a newly admitted student who has enrolled and then dropped all courses, your uOttawa email may no longer be active. Please send us your request to cancel UHIP directly to uhipramu@uOttawa.ca.

Student information

Student Number*

First Name*

Last name*

uOttawa Email Address*

Please indicate your healthcare plan*

Select Diplomatic Status Interim Federal Healthcare Plan (IFHP) Provincial Health Plan (OHIP, RAMQ, etc.) Sponsored Student Other

Specify, if 'Other'

Comments

Supporting document

Please make sure to upload the proof of your Pre-Approved Health Care Plan selected above:

Supporting document - Proof of your Pre-Approved Health Care Plan (Max file size: 2 Mb)*

Accepted formats : jpg, jpeg, png, doc, docx, pdf.Choose fileChosen file:

Please leave this field blank:

By submitting this form, you release uOttawa from any health coverage obligations. You also declare that you are aware that you will not be eligible for any services covered by UHIP during the period for which you have an exemption.