Online Forms

Claims — Request for Other Insurance Information
Claims — Request for Medical Information
Claims — Request for Dental Information
Claims — Request for Vision Information
COVID Test
International Medical Claim Form

Provider Forms

Pre-Cert Request Form

Paper Forms

COVID-19 Questionnaire
COVID-19 Questionnaire (Spanish)
COVID OTC Test Reimbursement Form
Medical Claim Form
Wellfleet Rx Member Reimbursement Form
Dental Claim Form
Vision Claim Form
SHIP Referral Request Form
PHI Release Form

Other

Women's Health & Cancer Rights Act
CA Students Notice of Free Language Assistance
HIPPA Notice of Privacy Practices of Wellfleet Insurance

UC Berkeley Student Health Insurance Plan members can sign up for access to your MySHIP Online account beginning July 29, 2019. In the meantime if you have questions regarding benefits or features of your SHIP plan, please contact the SHIP Office at (510) 642-5700.