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Plan Documents

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

Campus 2020-2021 Documents
Davis

Student Medical Summary of Benefits & Coverage (SBC)
Anthem Benefit Booklet
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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)
Anthem Benefit Booklet
Delta Dental Evidence of Coverage
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
OptumRx Pharmacy Plan Booklet
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
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
Delta Dental Evidence of Coverage (Spanish version)
Delta Dental Evidence of Coverage (Mandarin version)
OptumRx Pharmacy Plan Booklet
OptumRx Pharmacy Formulary
OptumRx Pharmacy Formulary Exclusions
Vision Plan Booklet
Vision Plan Booklet (Spanish version)
Vision Plan Booklet (Mandarin version)