Student Insurance and Consent Collection Form

CYBHI stands for the Children and Youth Behavioral Health Initiative, a California state program that helps schools expand student access to behavioral health services.

CVESD is committed to supporting students academically, socially, and emotionally. Through CYBHI, the district can offer on-campus counseling and behavioral health services at no cost to families. Parent/guardian permission is required to access the services.

No. All students can receive support, regardless of insurance status. However, families are asked to share insurance information so schools can coordinate services and ensure resources are available for more students.

No. CYBHI services provided at school sites come at no cost to families. The district does not bill co-pays, deductibles, or fees for services provided through CVESD.

Yes. If your child has insurance, the district may bill your insurance to cover the cost of the services. However, you will not be responsible for any out-of-pocket expenses. Services are always free for families.

No. Billing your insurance under CYBHI will not affect your coverage.

Yes. Providing this information is safe and confidential. All details are protected by federal privacy laws, including the Family Educational Rights and Privacy Act (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA).

Yes. The form allows you to enter information for multiple children, regardless of whether they have insurance.

Services from the School Social Worker/Counselor may include:

• One-on-one counseling sessions
• Small group support
• Skill-building activities (stress management, social skills, self-regulation)