Forms

Student Health Insurance

Premier Plan Forms:

UHCSR Claim Form 
Prescription Claim Form 
HPV Vaccine Medical Claim Form 
Prescription Extension Request Form 
To obtain prescriptions beyond the authorized 30 days when traveling outside of the United States.

Study Abroad Plan Forms:

CISI Claim Form 
CMI/ACE American Co. Claim Form 
CMI/ACE American Co. Claim Form Instructions
Study Abroad Waiver Form 
Students enrolled in Office of International Programs' Courses, Main Campus, are required to purchase the Study Abroad Plan, without the waiver option.

EFL Plan Forms:

EFL Medical Claim Form 
EFL RX Claim Form