a guide to
STUDENT HEALTH SERVICES

UNIVERSITY OF DELAWARE

Newark, Delaware 19716-8101
2003-2004

Including the Voluntary
Student Accident and Sickness Plan

Nationwide Life Insurance Company

Policy Number: 3020010701

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Most of the files listed below are pdf files. If you do not have software on your computer for viewing and printing pdf files the freely available Adobe Acrobat reader can be downloaded.

Description of Student Health Service and Student Insurance Plan

CLAIM FORM (IN PDF FORMAT)

Application for Insurance:

To enroll online by credit card:

Credit Card Application through University Health Plans Website

To enroll by check using paper form or to enroll by credit card using paper form, print out and complete form below and mail forlowing insutructions on form.

Paper Insurance Application for Domestic Graduate and Undergraduate Students (Funded and Non-Funded) and all Post Docs. (International students see below). Please be sure to print out, complete and return both pages.

The Student Insurance Program is mandatory for University of Delaware International Students (excluding Post Docs) here on J or F visas. If you have equivalent insurance with claims processing in the United States, you may waive the insurance at the Foreign Students and Scholars Office. You must make application to waive the insurance before February 2004. The University will automatically charge you for single Blue Plan coverage International student who wish to upgrade to the Blue and Gold Plan and/or who wish to add a spouse and/or children should use this application.

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This website is not designed to respond to personal concerns nor emergencies. For emergency information, please call Student Health Services at 831-2226, or contact one of the facilities above.