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Measles and Mumps Requirement Form
Domestic students, you will need to complete the form and submit it to the Center for Student Health
and Counseling for processing.
International Student Measles and Mumps
Requirement Form
If you are an international student, please complete this form and submit it to the Center
for Student Health and Counseling for processing.
Authorization of Release
Please complete this form if you need to authorize your medical and/or mental health
records to be released or discussed with an outside provider.
2007-2008 Academic Year Insurance Brochure
The brochure can also be picked up at the Center for Student Health and Counseling
UCB 200 or the cashiers window in NH on campus. At the end of this brochure you will
also find the enrollment form for the extended insurance plan if you are interested
in getting a more comprehensive plan in addition to the basic insurance.
2007-2008 Insurance Card
Claim Forms: Please note that claim forms are not required. To submit a claim, make a copy of
the bill/receipt, write your name, medical ID number, PSU ID number, and what university
you attend directly on the bill/receipt. Submit to:
Ameriben/IEC Group
PO Box 7186
Boise, ID 83707
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