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Immunizations
New Students
Graduate Division Student Immunization Requirements 2017
Professional Student Immunization Requirements 2017
Current Students
Hep B Declination
TB Mask Fit
Immunization Consent Form
Insurance
UC SHIP 2016-2017
Cost of Care Handout
UC Student Health Insurance Plan (UC SHIP) Brochure
Student and Covered Dependent(s) Benefits Summary (English)
Student and Covered Dependent(s) Benefits Summary (Spanish)
Student and Covered Dependent(s) Benefits Summary (Mandarin)
UC SHIP Medical Benefits Booklet
Medical Claim Form
UC SHIP Member Reciprocity Claim Form
Prescription Claim Form
Prescription Insurance Summary
Approved Formulary Drug List
Formulary Help Document
Exclusion List
Prescription Mail Order Form
Delta Dental Benefits Summary
Delta Dental Explanation of Coverage
Delta Dental Claim Form
Vision Insurance Summary
Vision Explanation of Coverage
Anthem Blue View Vision Claim Form
International Claim Form
UC SHIP 2015-2016
Insurance Benefit Chart
UC Student Health Insurance Plan (UC SHIP) Brochure *
Student Benefits Summary *
Dependent Benefits Summary *
UC SHIP Benefits Booklet *
Medical Claim Form
Prescription Insurance Summary
Dependent Prescription Insurance Summary *
Catamaran Mobile App
Prescription Claim Form
Prescription Mail Order Form
Approved Formulary Drug List
Delta Dental Benefits Summary
Delta Dental Explanation of Coverage
Delta Dental Claim Form
Vision Insurance Summary
Vision Explanation of Coverage
Anthem Blue View Vision Claim Form
International Claim Form
* (Updated 3/24/16 with changes retroactive to 8/1/15 to satisfy "Minimal Essential Coverage" requirements by ACA)
Enrollment Forms
Voluntary UC SHIP Enrollment Form
Dependent Enrollment Form for Registered Graduate Division and School of Medicine Students
Dependent Enrollment Form for Registered Professional School Programs Students
Scholars and Researchers Enrollment Form - Bridges Curriculum
Scholars and Researchers Enrollment Form - Graduate Division and School of Medicine
Scholars and Researchers Enrollment Form - Professional School Programs
Scholars and Researchers Dependent Enrollment Form
Affidavit of Domestic Partners
Waiver
Criteria Worksheet
Glossary of Medical Insurance Terminology
Insurance Waiver Appeal Form
Insurance Waiver Reversal Form
Travel
Travel Insurance
Travel Screening Questionnaire
Traveler's Diarrhea
Malaria
Trauma
International Claim Form
HIPAA -- non-students only
HIPAA Privacy Practice
HIPAA Addendum
Medical Records
Release of Health Information
Revocation of Authorization to Release Health Information
Mental Health
Assisting Students In Distress
Assisting Peers In Distress
Caring for Yourself and Your Colleagues
Promoting Student Mental Health Faculty & Staff Handbook + Training Resources
