United Healthcare Brochure 2009 - 2010
Insurance Waiver Form
Insurance Application Form (You are automatically enrolled, but if you waived the insurance, then you may re-apply using this form.)
Temporary Student Insurance Card
Optional Major Medical Enrollment Form
Student Medical Insurance Referral Form
Domestic Partner Affidavit
Domestic Dependent Enrollment Form
International Dependendent Enrollment Form
Insurance Enrollment Form for J-1 Scholars and English Language Program Students and their Dependents
Special Category Form for J-1 Visa students
Special Category Form for all other situation
Personal Representative Appointment Form (PAR)
Insurance Prescription Submission Form
Pharmacy Reimbursement Claim Form
United Health Care offers students individual dental coverage at a unique rate. Although this dental insurance is not affiliated with Ohio University, we have provided links to the necessary forms below. This is NOT an OU student insurance policy.
Dental Benefit Summary
Dental Enrollment Form