University of North Alabama

Our Partner in Good Health


Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.


Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.


Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

*You can submit the form online by signing in to My Account.