Forms and Documents WHAT YOU NEED TO KNOW The forms below are for the 2024–2025 academic year. Prior year forms and documents are available upon request. New Student Resources UC SHIP Benefits Overview: UC Irvine [PDF] Care You Can Count On Brochure [PDF] Medical Benefit Booklet [PDF] Medical Summary of Benefits & Coverage (SBC) [PDF] Anthem Medical Claim Form [PDF] LiveHealth Online Flyer [PDF] Prescription Drugs Optum Rx Formulary [PDF] Optum Rx Formulary Exclusions [PDF] Optum Rx Prescription Drug Claim Form [PDF] Prescription Drug Plan Booklet [PDF] Dental Delta Dental Benefit Booklet (English) [PDF] Delta Dental Benefit Booklet (Mandarin) [PDF] Delta Dental Benefit Booklet (Spanish) [PDF] Delta Dental Claim Form [PDF] Delta Dental Benefit Highlights (Keep Smiling) Flyer [PDF] Vision Blue View Vision Plan Benefit Booklet (English) [PDF] Blue View Vision Plan Benefit Booklet (Mandarin) [PDF] Blue View Vision Plan Benefit Booklet (Spanish) [PDF] Blue View Vision Claim Form [PDF] Related Pages Contacts Mobile Apps
