Forms and Links

Click to view and/or print the following:

FORMS

2019-2020 Student Health Insurance Program Summary Brochure - Brochure which contains detailed information on the plan benefits, eligibility and other important information. 

2019-2020 Frequently Asked Questions - Provides answers to common questions about the Student Health Insurance Plan. 

2018-19 Student Health Insurance Program Summary Brochure - Brochure which contains detailed information on the plan benefits, eligibility and other important information. 

2018-19 Frequently Asked Questions - Provides answers to common questions about the Student Health Insurance Plan.

Optum Rx Prescription Drug Claim Form

UnitedHealthcare Student Resources Claim Form

LINKS
Health Services - Provides a link to the Health Services website.

How to Access Plan Benefits - Provides information needed to seek care.

Leave of Absence - Provides informaiton on eligibility and enrollment procedures for students who wish to continue insurance coverage while on an approved leave of absence.

Dependent Enrollment - Provides information on how insured students may enroll their eligible dependent(s) in the Student Health Insurance Plan.

Contact Information  & Links - Provides a list of contacts for any question you may have about student health insurance pretaining to enrollment, eligibility, benefits, prescriptions, claims and provider networks.