Student Insurance Forms & Documents

General

Claim Information Form (PDF)

Notice of Change of Insurance (11-12) (PDF)

Payment of Out-of-Network Benefits (PDF)

Pharmacy Claim Form (PDF)

Scholastic Emergency Services Program Guide (PDF)

Scholastic Emergency Services Program Flyer (PDF)

UnitedHealth Allies Discount Program Member Handbook (PDF)

Privacy

Authorization from Individual (PDF)

Personal Representative Appointment (PDF)

SHC Release of Info to UHCSR (PDF)

2011-2012 Policy

2011 Benefits Summary (PDF)

2011 Continuation Enrollment Form (PDF)

2011 Dependent Enrollment Form (PDF)

2011 Plan Brochure (PDF)

2011 Make the Most of Your Plan (PDF)

2011 Voluntary Dental Plan Enrollment Form (PDF)

2011 Voluntary Dental Plan Summary (PDF)