Student Health Insurance

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Download Forms and Documents (2008-2009)      

You will need Acrobat Reader to download any of the following PDF files.

• "How to..." waive out of or enroll in Student Health Insurance
  Step by Step guides to waiving out of or enrolling in the various Student Health Insurance plans.
   
• Health Insurance - Be Informed Before You Buy (PDF)
  This form includes eligibility requirements, deadlines, rates, and a general comparison between the three plans
  
  Waiver (more info here)
   
• Online WAIVER Process Information Sheet (PDF)
  This form includes instructions on how to complete the online waiver process
  
  Delos Health Insurance (Plan A & B) (more info here)
   
• Delos Insurance Brochure (PDF)
  This brochure includes benefit information for both Plan A and Plan B; please note Delos Health Insurance is available to any Fuller student who is registered for 1 or more units on any Fuller campus.  See pages 2 and 3 of the brochure for more information on who is eligible to purchase this insurance.
   
• How to APPLY for Delos Insurance Information Sheet (PDF)
  Instructions on how to apply for Delos Health Insurance Online
   
• Health And Dental Continuation Form (PDF)
  This form is only for those who are continuing insurance coverage one quarter beyond graduation or being enrolled in classes (payment must be included with form).
  
  Kaiser HMO (more info here)
   

• How To Enroll In Kaiser (PDF)

  Click on the link above to view a step by step guide to enrolling in Kaiser.
   

• Kaiser Benefits Summary
  Summary of medical benefits provided through Kaiser.
   

• Kaiser Enrollment Form (PDF)

  If you are having trouble enrolling online or the online enrollment process is not available to you, you may also print and fill out the above form and turn it in to the Student Health Insurance office.
   


United Concordia DHMO (more info here)
 
• How To Enroll In Voluntary Student Dental Insurance (PDF)
  Click here for a step by step guide to signing up for Voluntary Student Dental Insurance.
   
• Dental Insurance - Be Informed Before You Buy (PDF)
  This form includes eligibility requirements, deadlines, rates, and a general description of the coverage.
   
• United Concordia Enrollment Form (PDF)
  This form is required every Fall quarter or the first quarter in which you are eligible to purchase the Voluntary Student Dental Insurance.
   
• Health and Dental Continuation Form (PDF)
  This form is only for those who are continuing insurance coverage one quarter beyond graduation or being enrolled in classes (payment must be included with form).
   
• United Concordia Schedule of Benefits (PDF)
  Summary of benefits provided through the United Concordia DHMO
   
• Davis Vision Discount Program (PDF)
  This year the United Concordia Dental Insurance coverage includes a vision discount program.  Click on the link above to see what benefits are provided.
  
  Insurance Cancellation - Medical & Dental
   
• Health Insurance Cancellation Form (PDF)

  • This form is for students who meet the eligibility criteria for cancelling their medical and/or dental insurance by the quarterly deadline for the applicable quarter.

  • To waive insurance if you have coverage that meets the minimum requirements, go online to www.renstudent.com/fuller to complete the process.

  • Submit this form and proper documentation to the Student Health Insurance Office by the applicable quarterly deadline.