Helpful Resources & Forms

This page contains a variety of helpful resources and commonly used forms. If you need additional assistance or have questions about the appropriate use of these forms, please call Customer Service at 1-800-767-0700, or send us an email.


  • In order to share specific health information with someone other than yourself, we need your permission. Simply print off the PRI-FO-09 Authorization Form and fax or mail it to the address given on the form once you have filled it in.
  • To authorize another individual to act on your behalf for health insurance matters with UnitedHealthcare StudentResources, simply login to My Account and complete the Personal Representative Appointment in the Forms and Letters section of the home screen. Alternatively, you may complete the Personal Representative Appointment Form and fax it to the number indicated on the form.
  • If you’ve received requests for more information regarding a claim, complete the Claim Information Form and mail it to:
    UnitedHealthcare StudentResources
    P.O. Box 809025
    Dallas, TX 75380-9025
  • To request reimbursement for a pharmacy (OptumRx) claim, complete the Prescription Reimbursement Request Form and mail it along with your original pharmacy receipt(s).


These files are in PDF format. To read and print a PDF file you must have Adobe Acrobat Reader Software 4.0 installed on your computer. Download the Adobe Acrobat Reader