FORMS

  • Authorization to Release Information - Complete and return this form if you want to give us permssion to give information or records about you to another person.
  • Student COB Questionnaire - When requested, submit this form with informaion about other insurance coverage for you and/or your dependents.                                     
  • Detail of Injury Questionnaire - When requested, submit this form with information about an injury you have in order to process a medical claim. 
  • Prior Authorization Request Form for Medical Procedures - Providers should complete this form when seeking prior authorization for medical procedures.
  • Student Claim Form - When requested, submit this form with information about your illness or injury. Check your plan brochure for claim form requirements.
  • Athletic Injury Claim Form - Submit this sports claim form within 20 days from the date of your sports injury (or as soon as reasonably possible). 

 

RESOURCES

  • NeedyMeds - An online information resource of programs that provide assistance to people who are unable to afford their medications and health care costs.
  • HealthCare.gov - Learn more about the new health care law.
  • Preventive Care - Learn more about what's covered for preventive care under the Affordable Care Act.