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UC Merced

Coverage for the Journey Ahead

  • Benefits 101
    • Terms to Know
    • About UC SHIP
  • Eligibility and Enrollment
    • Eligibility
    • Enrolling in Coverage
    • Waiving Coverage
    • Paying for Coverage
    • When Coverage Begins and Ends
  • Coverage
    • Medical
    • Mental Health
    • Prescription Drugs
    • Dental
    • Vision
  • Getting Care
    • Your First Stop for Care
    • When You’re Away from Campus
    • Extending Coverage After Graduation
    • Filing Claims
    • When You’re Covered by More Than One Plan
  • Resources
    • Contacts
    • Mobile Apps
    • Forms and Documents
UC Merced
  • Benefits 101
    • Terms to Know
    • About UC SHIP
  • Eligibility and Enrollment
    • Eligibility
    • Enrolling in Coverage
    • Waiving Coverage
    • Paying for Coverage
    • When Coverage Begins and Ends
  • Coverage
    • Medical
    • Mental Health
    • Prescription Drugs
    • Dental
    • Vision
  • Getting Care
    • Your First Stop for Care
    • When You’re Away from Campus
    • Extending Coverage After Graduation
    • Filing Claims
    • When You’re Covered by More Than One Plan
  • Resources
    • Contacts
    • Mobile Apps
    • Forms and Documents

Forms and Documents

WHAT YOU NEED TO KNOW

The forms below are for the 2022/2023 academic year. Prior year forms and documents are available upon request.

New Student Resources

UC SHIP Benefits Overview: UC Merced [PDF]
Care You Can Count On Brochure [PDF]

Medical

Benefit Booklet [PDF]

Medical Summary of Benefits & Coverage (SBC) [PDF]

Anthem Medical Claim Form [PDF]

Prescription Drugs

OptumRx Formulary [PDF]

OptumRx Formulary Exclusions [PDF]

OptumRx Prescription Drug Claim Form [PDF]

Prescription Drug Plan Booklet [PDF]

Dental

Delta Dental Benefit Booklet [PDF]

Delta Dental Claim Form [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

Benefits 101

  • Terms to Know
  • About UC SHIP

Eligibility and Enrollment

  • Eligibility
  • Enrolling in Coverage
  • Waiving Coverage
  • Paying for Coverage
  • When Coverage Begins and Ends

Coverage

  • Medical
  • Mental Health
  • Prescription Drugs
  • Dental
  • Vision

Getting Care

  • Your First Stop for Care
  • When You’re Away from Campus
  • Extending Coverage After Graduation
  • Filing Claims
  • When You’re Covered by More Than One Plan

Resources

  • Contacts
  • Mobile Apps
  • Forms and Documents

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