UVa Health Plans
- Authorization to Disclose Protected Health Information (PDF)
- Authorization to Disclose Protected Health Information to Family Member or Other Person (PDF)
- COBRA 2013 Eligibility and Enrollment for UVA Health Plan and Davis Vision
- COBRA 2012 Eligibility and Enrollment for UVa health Plan and Davis Vision (PDF)
- Catamaran Mail Order Form (PDF)
- Catamaran Prior Authorization (PDF)
- Catamaran Reimbursement Form (PDF)
- Dental Claim Form (PDF)
- Housestaff Medical Enrollment Form (PDF)
- Aetna Medical Claim Form (PDF)
- Southern Health Medical Claim Form (PDF)
- Mid-Year Qualifying Event Affidavit (PDF)
- Foreign Country Enrollment Form (PDF)
- UVa Health Plan Enrollment Form Medical Center Employees (PDF)
- UVa Health Plan Enrollment Academic Employees—Click on Benefits@ above
- Postdoc and Research Associate Medical Enrollment Form (PDF)
- Southern Health Certificate of Coverage (PDF)
- Medicare Part D Notice (PDF)
- Privacy Notice (PDF)