University of Colorado Denver

Below you will find various forms sometimes needed to file claims along with the enrollment/waiver form.  If you have any questions about any of these forms or do not see the form you need please contact the Student Health Office at 303-724-7674.

• Continuation enrollment form 2012-13_AMC_ContinuationForm.pdf
• Dependent Enrollment Form 2012-13_UC-AMC_Dependent_Enroll.pdf
• Plan A temp card 2012-13 AMC 202512-1 Plan A Temp ID card.pdf
• Plan B temp card 2012-13 AMC 202512-2 Plan B Temp ID card.pdf
• Medical/Massage/Acupuncture Claim Form 12-13UCD AMC 2012-13 Claim Form - 08 28 2012.pdf
• Prescription Claim form  ESI prescription reimbursment.pdf
• Prescription Mail Order form AM2-Mail Order.doc

Forms from plan year 11-12

• Nuva Ring Reimbursement form Nuva Ring 11.12.pdf
• Medical Claim formUCD AMC 11-12 Claim Form.pdf