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: UCSC [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]