Student Health Insurance Forms
If you have any questions about a form or do not see the form you need,
please email studenthealthinsurance@cuanschutz.edu.
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Dental Claim Form
(pdf)
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Continuity of Care Form
Complete and submit a Continuity of Care Form if you are currently receiving ongoing care or if you have services scheduled. Please do not complete and submit the form if you are not currently receiving ongoing care or if you do not have upcoming services scheduled. This form may be used for mental health that is not in the Anthem network.
Personal Representative Appointment Form
This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with Anthem Student Advantage.
Prescription Reimbursement Form
Carleon Rx claim form to request reimbursement for covered medications purchased at retail cost.
Continuation Coverage Enrollment
Graduates can opt in for 1-3 months of coverage through the CU Anschutz Student Insurance Plan. If you are a recent graduate looking to extend your coverage, please email studenthealthinsurance@cuanschutz.edu.
The monthly premiums for continued coverage after graduate is $1,028 per month.
Please note: This is only an option for students who were enrolled in the CU Anschutz Student Health Insurance Plan for the semester in which they graduated.