Student Health Insurance

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Download Forms and Documents (2007-2008)      

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

• Health & Dental Insurance Checklist (PDF)
  Click here for a helpful summary of what is available and/or required
   
• 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
• Delos Health Insurance Form (PDF)
  This form is for those students who wish to continue their Delos Insurance for one additional quarter; please note that full payment must be included with this form.  More information about extending student health insurance can be found on page 3 of the Delos Brochure.
  
  Blue Cross Power Select HMO (more info here)
   
• Blue Cross Health Insurance Form (PDF)
  This form is for those Pasadena Campus students who are residing in Southern California and wish to begin or continue their Blue Cross Power Select HMO health insurance; information on who is eligible for this plan is included above in the Health Insurance - Be Informed Before You Buy.
• Blue Cross Benefits Summary (PDF)
  Summary of medical benefits provided through the Blue Cross Power Select HMO plan.
• Blue Cross Prescription Benefits Summary (PDF)
  Summary of prescription benefits provided through the Blue Cross Power Select HMO plan.
• Blue Cross Enrollment Form (PDF)
  This form is required every Fall quarter or the first quarter in which you are eligible to purchase the Blue Cross Power Select HMO plan.
  
  
  United Concordia DHMO (more info here)
   
• Voluntary Student Dental Insurance Form (PDF)
  This form is for those students who wish to begin or continue the Voluntary Student Dental Insurance provided through United Concordia; please note this insurance is available to any student residing in California registered for 1 or more units.  More information concerning eligibility is included below in the Dental Insurance - Be Informed Before You Buy.
• 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.
• 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.

  • To waive insurance if you have comparable coverage, 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.