Plan Documents

For previous year's documents, please visit these pages:

Campus	2018-2019 Documents
Davis	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
Hastings	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
Irvine	Student Medical Summary of Benefits & Coverage (SBC): Grads Student Medical Summary of Benefits & Coverage (SBC): Undergrads Anthem Benefit Booklet: UCI Graduates Anthem Benefit Booklet: UCI Undergraduates Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet: UCI Graduates OptumRx Pharmacy Plan Booklet: UCI Undergraduates OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
Los Angeles	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
Merced	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
Riverside	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
San Diego	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
San Francisco	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
Santa Barbara	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)
Santa Cruz	Student Medical Summary of Benefits & Coverage (SBC) Anthem Benefit Booklet Delta Dental Evidence of Coverage OptumRx Pharmacy Plan Booklet OptumRx Pharmacy Formulary OptumRx Pharmacy Formulary Exclusions Vision Plan Booklet Vision Plan Booklet (Spanish version) Vision Plan Booklet (Mandarin version)