Student Insurance and Consent Collection Form to Support Student Services

The Chula Vista Elementary School District (CVESD) provides behavioral health services to support every student’s success. Families are asked to complete the Student Insurance and Consent Collection Form as part of this effort.

The information collected allows CVESD to access state funding through the Children and Youth Behavioral Health Initiative (CYBHI), a California program that strengthens school-based health services. Through this program, students can receive counseling, social-emotional learning opportunities, and other resources promoting their well-being.

Providing this information is safe and confidential. Completing the form will not change your student’s healthcare coverage or limit their access to services. All students are eligible for behavioral health support, regardless of insurance status. There are no costs to families, and the district does not bill for co-pays, deductibles, or school-based care.

To complete the Student Insurance and Consent Collection Form, available in English and Spanish, click here.

Below are some frequently asked questions and answers.

1. What is CYBHI? CYBHI stands for the Children and Youth Behavioral Health Initiative, a California state program that helps schools expand student access to behavioral health services.
2. Why is my child’s school participating? 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.
3. Does my child need insurance to receive 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.
4. Will this cost me anything? 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.
5. Will CVESD bill my insurance? 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.
6. Will this affect my insurance coverage? No. Billing your insurance under CYBHI will not affect your coverage.
7. Is my child’s information confidential? 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).
8. If I have multiple children attending the district, can I include them all? Yes. The form allows you to enter information for multiple children, regardless of whether they have insurance.
9. What kinds of services are available? Services may include:

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