Student Insurance Forms & Documents
2024-2025 Policy
2024 Continuation Enrollment (through UHCSR MyAccount)
2024 Dependent Enrollment Form (through UHCSR MyAccount)
2024 Plan Brochure/Certificate (PDF)
2024 Schedule of Benefits (PDF)
2024 Summary Brochure (PDF)
2024 Student Insurance Opt-In/Enrollment Form (online)
2024 Student Insurance Waiver Request Form (online)
2023-2024 Policy
2023 Dependent Enrollment Form (through UHCSR MyAccount)
2023 Plan Brochure/Certificate (PDF)
2023 Schedule of Benefits (PDF)
2023 Summary Brochure (PDF)
2023 Student Insurance Opt-In/Enrollment Form (online)
2023 Student Insurance Waiver Request Form (online)
General
Claim Information Form (PDF)
Global Travel Plus Assistance Service Brochure (PDF)
Notice of Change of Insurance (online)
Payment of Out-of-Network Benefits (PDF)
Pharmacy Claim Form (PDF)
Pharmacy Prescription Drug List (PDF)
UnitedHealth Allies Discount Program Member Handbook (PDF)
Privacy
Authorization from Individual (PDF)Personal Representative Appointment (PDF)
SHC Release of Info to UHCSR (PDF)
