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Immunizations
New Students
Graduate Division Student Immunization Requirements
Professional Student Immunization Requirements
All Students
N95 Mask Fit Test Clearance
TB Sign and Symptom Review Form
Immunization Consent Form
Flu Declination Letter [UCOP-fillable]
Insurance
UC SHIP 2021-2022
Cost of Care Handout
UC Student Health Insurance Plan (UC SHIP) Brochure
Student and Covered Dependent(s) Benefits Summary (English)
UC SHIP Medical Benefits Booklet
UC SHIP Student Health Mobile App Flyer
Medical Claim Form
UC SHIP Member Reciprocity Claim Form
UC SHIP Refund Request Form
Prescription Claim Form
Prescription Insurance Summary
Approved Formulary Drug List
Exclusion List
Prescription Mail Order Form
Delta Dental Benefits Summary
Delta Dental Benefits Booklet
Delta Dental Benefits Booklet (Chinese)
Delta Dental Benefits Booklet (Spanish)
Delta Dental Claim Form
Vision Insurance Summary
Vision Benefits Booklet
Vision Benefits Booklet (Chinese)
Vision Benefits Booklet (Spanish)
Anthem Blue View Vision Claim Form
International Claim Form
UC SHIP 2020-2021
Cost of Care Handout
UC Student Health Insurance Plan (UC SHIP) Brochure
Student and Covered Dependent(s) Benefits Summary (English)
UC SHIP Medical Benefits Booklet
UC SHIP Student Health Mobile App Flyer
Medical Claim Form
UC SHIP Member Reciprocity Claim Form
UC SHIP Refund Request Form
Prescription Claim Form
Prescription Insurance Summary
Approved Formulary Drug List
Exclusion List
Prescription Mail Order Form
Delta Dental Benefits Summary
Delta Dental Benefits Booklet
Delta Dental Benefits Booklet (Chinese)
Delta Dental Benefits Booklet (Spanish)
Delta Dental Claim Form
Vision Insurance Summary
Vision Benefits Booklet
Vision Benefits Booklet (Chinese)
Vision Benefits Booklet (Spanish)
Anthem Blue View Vision Claim Form
International Claim Form
Voluntary and Dependent Plan Enrollment
UC SHIP offers voluntary enrollment to students on a leave of absence, filing fee, or for one quarter after coverage ends post graduation. Dependent coverage is also available. To enroll in the voluntary plan or to enroll your dependent(s) open the corresponding rate sheet below and click on the "here" link.
If you are a Program Coordinator wishing to enroll a student in health insurance under “Filing Fee” status please email [email protected].
Voluntary UC SHIP Rate Sheet - Graduate Programs
Voluntary UC SHIP Rate Sheet - Professional Programs
Voluntary UC SHIP Rate Sheet - Professional Programs Summer 2021
Dependent Enrollment Rate Sheet for Registered Graduate Division Students
Dependent Enrollment Rate Sheet for Registered Professional School Program Students
Dependent Enrollment Rate Sheet for Registered Professional School Program Students Summer 2022
Dependent Enrollment Rate Sheet for Scholars and Researchers
Please click here for all qualifying event enrollments (marriage/divorce, loss of prior coverage, newborns, etc.). The form must be submitted within 31 days of your qualifying event date.
Scholars and Researchers Enrollment Form - Bridges Curriculum
Scholars and Researchers Enrollment Form - Graduate Division
Scholars and Researchers Enrollment Form - Professional School Programs
Waiver
Criteria Worksheet
Glossary of Medical Insurance Terminology
Travel
Travel Insurance
Travel Screening Questionnaire
Traveler's Diarrhea
Malaria
Trauma
International Claim Form
Privacy Notices
Consent to Medical Treatment and Privacy Notice – students only
HIPAA Notice of Privacy Practices – non-students only
Public Health
Coronavirus Symptom Self-Monitoring Formkeywords: covid, covid-19, coronavirus, testing, sars, sars-cov-2
UCSF Continue to work/Return to work Guidelines For Personnel
Mental Health
Promoting Student Mental Health Faculty & Staff Handbook + Training Resources
