University of Southern California
Eric Cohen Health Center

Health Insurance Forms

Health Insurance and Waivers

Claim Form, medical This document uses Adobe Acrobat
Claim Form, dental This document uses Adobe Acrobat
Pre-Authorization Form, dental This document uses Adobe Acrobat
USC Student Health Insurance Plan  This document uses Adobe Acrobat
Enrollment Form, medical  This document uses Adobe Acrobat        
Enrollment Form, medical (Off-Campus)  This document uses Adobe Acrobat 
Medical Benefit Chart for Students  This document uses Adobe Acrobat
Medical Benefit Chart for Off-Campus Students  This document uses Adobe Acrobat
Medical Benefit Chart for Students Studying Overseas  This document uses Adobe Acrobat
Pharmacy Benefits for Students  This document uses Adobe Acrobat
Pharmacy Benefits for Off-Campus Students  This document uses Adobe Acrobat
Pharmacy Claim Form  This document uses Adobe Acrobat
Voluntary Student Dental Plan  This document uses Adobe Acrobat
USC Voluntary Student Dental Plan, enrollment form  This document uses Adobe Acrobat 
Optional Dental Plan Benefits for Students and Eligible Enrolled Dependents  This document uses Adobe Acrobat
Waiver Form  This document uses Adobe Acrobat