# 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

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This form is to be used by **international students** who have coverage under a **[UHIP Pre-Approved Health Care Plan](https://uhip.ca/uhip-services/coverage-details/#getting-an-exemption-from-uhip)**.

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)](https://www.seuo-uosu.com/)** if you are an **undergraduate** or the **[Graduate Student Association (GSAED)](https://gsaed.ca/en/home/)** 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

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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

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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**.