Student Insurance Forms & Documents

2025-2026 Policy

2025 Continuation Enrollment (through UHCSR My Account)
2025 Dependent Enrollment Form (through UHCSR My Account)
2025 Plan Brochure/Certificate (PDF)
2025 Schedule of Benefits (PDF)
2025 Summary Brochure (PDF)
2025 Student Insurance Opt-In/Enrollment Form (online)
2025 Student Insurance Waiver Request Form (online)

General

Claim Information Form (PDF)
Global Travel Plus Assistance Service Brochure (PDF)
Change of Insurance (online)
Payment of Out-of-Network Benefits (PDF)
Pharmacy Claim Form (PDF)
Pharmacy Prescription Drug List (PDF)

Privacy

Authorization from Individual (PDF)
Personal Representative Appointment (PDF)
SHC Release of Info to UHCSR (PDF)