Student Insurance Forms & Documents

General
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)
 
Privacy
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)