Student Insurance Forms & Documents

Claim Information Form (PDF)
Global Emergency Services Program Guide (PDF)
Notice of Change of Insurance (PDF)
Payment of Out-of-Network Benefits (PDF)
Pharmacy Claim Form (PDF)
UnitedHealth Allies Discount Program Member Handbook (PDF)
Authorization from Individual (PDF)
Personal Representative Appointment (PDF)
SHC Release of Info to UHCSR (PDF)
2017-2018 Policy

2017 Benefit Summary (PDF)
2017 Continuation Enrollment Form (PDF)
2017 Dependent Enrollment Form (PDF)
2017 Plan Brochure (PDF)
2017-2018 Student Insurance Enrollment Request Form (online)
2017-2018 Student Insurance Waiver Decision Appeal Form (online)
2017-2018 Student Insurance Waiver Request Form (online)
2017-2018 Voluntary Dental Plan Benefit Summary (PDF)
2017-2018 Voluntary Dental Plan Enrollment Form (PDF)