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Student Health and Counseling Services

UC Student Health Insurance Plan
Downloadable Forms

Some of the files on this site are provided in portable document format (pdf). A program that can read and/or print pdf files, like Adobe Acrobat Reader, may be required.

2011-2012 Academic Year Forms

Waivers

  • Appeal of UC SHIP Waiver Denial - Students may appeal a waiver denial within two weeks of receiving notice of denial.
  • Request to Cancel UC SHIP Waiver (pdf) - Students may cancel an approved wavier application and enroll in SHIP.
  • Late Waiver Application (pdf) - Students who are admitted to the university after the waiver deadline can fill out this form and submit it along with a copy of their current insurance ID card to the Insurance Services department for consideration of a UC SHIP waiver.

Benefits Checklist

Below are listed the UC SHIP Benefits checklists for services rendered at the Student Health and Wellness Center as well as for outside providers. They give a brief overview of your benefits. Students are provided with a copy of these checklists when they are issued a referral.