View or download forms and brochures for 2024-2025.
To view forms and brochures for 2023-2024, click here.
Our office cannot accept forms with credit card information by email. Please mail or bring directly to the address listed at the bottom of the form.
Forms
Student Health Benefit Plan
- Enroll and Change Form 2024-2025 (pdf)
- Student Information Release 2024-2025 (pdf)
- Learning Abroad Waiver 2024-2025 (pdf)
- Short-term Coverage Extension Enrollment Form 2024-2025 (pdf)
International Students
- International Student Enroll and Change Form 2024-2025 (pdf)
- International Student Waiver 2024-2025 (pdf)
- OPT International Student Enroll and Change Form 2024-2025 (pdf)
- OPT International Student Dental Enrollment Form 2024-2025 (pdf)
International Scholars
- International Scholar Enroll and Change Form 2024-2025 (pdf)
- International Scholar Payment Form 2024-2025 (pdf)
- International Scholar Waiver Form 2024-2025 (pdf)
- International Scholar Department Authorization 2024-2025(pdf)
Student Dental Plans
ID Cards
You can access a virtual or temporary member ID card on Blue Cross and Blue Shield of Minnesota's member website.
You can also access your ID card electronically in the BlueCrossMN mobile app. Once you're enrolled on the plan, create an account with Blue Cross, then download and begin using the mobile app. The app also gives you access to check claims or find a doctor. The mobile app can be downloaded on the App Store or on Google Play.
You will also receive a health plan card and information to your U.S. mailing address on file in MyU. To review or update your mailing address, go to the MyU Student Center and click on "My Info." Under Address, update your mailing address.
If you recently updated your address and think your health plan information or card may have been sent to your old address, email your name, student ID number, and the message “I have updated my U.S. mail address with the University and would like a new card sent to me” to [email protected]. You will also want to provide the new address. The Office of Student Health Benefits must receive confirmation from you that your U.S. mail address is correct before issuing a new card.
Brochures and Documents
Student Health Benefit Plan
Student Dental Plans
- Student Dental Plan Enrollment Brochure (pdf)
- Preventive and Periodontal Plan Summary of Benefits (pdf) (included in SHBP for primary members) 24-25 version coming soon
- Optional Dental Buy-Up Plan Summary of Benefits (pdf) 24-25 version coming soon
- Pediatric Dental Plan Summary of Benefits (pdf) 24-25 version coming soon
- Preventive and Periodontal Dental Plan Full Benefits Summary (pdf) (included in SHBP for primary members) 24-25 version coming soon
- Optional Dental Buy-Up Plan Full Benefits Summary (pdf) 24-25 version coming soon
- Pediatric Dental Plan Full Benefits Summary (pdf) 24-25 version coming soon
Health Plan Benefits Summaries
Choose your campus below to view or download your benefit summaries: