Harvard University Health Services

Insurance Forms


Student Dependent Health Plan Enrollment Form

Harvard University Student Health Plan Waiver Application Form

Student Health Plan Waiver Rescind Form

Prescription Drug Reimbursement Form – Medco 

Prescription Drug Reimbursement Form – Pharmacare 

Student BlueCross BlueShield Claim Form 

Student Dental Enrollment Form

Insurance for Leave of Absence 

International Claim Form