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  • UC San Francisco
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  • UC Santa Cruz
UC San Diego

Coverage for the journey ahead

  • About UC SHIP
    • Overview
    • Terms to Know
  • 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
    • Where to Get 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 San Diego
  • About UC SHIP
    • Overview
    • Terms to Know
  • 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
    • Where to Get 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 2024-25 academic year. Prior-year forms and documents are available upon request.

New student resources

UC SHIP Benefits Overview: UCSD [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 Benefits Highlights (Keep Smiling) Flyer (English) [PDF]

Delta Dental Benefits Highlights (Keep Smiling) Flyer (Mandarin) [PDF]

Delta Dental Benefits Highlights (Keep Smiling) Flyer (Spanish) [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

About UC SHIP

  • Overview
  • Terms to Know

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

  • Where to Get 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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