ENROLLMENT / SERVICE REQUEST FORMS

UHC Employee Enrollment Form

UHC Employee Enrollment form for Dependents

LD Enrollee Application Supplement

UHC COBRA Enrollment

Member Service Request Form

UHC Health Insurance Claim Form

HIPAA Disclosure Authorization Form

WELCOME DOCUMENTS

• Welcome Brochure

• Brochure – While you are waiting for your coverage to start.

• New Member Checklist

• Find cost and care

• Premium Designation

• Quick Care Options

United Healthcare App / Website Registering

• UHC App Flyer

• Why Register Online

MEDICAL INFORMATION

• MEDICAL POLICY

• MEDICAL CERTIFICATE

• FINDING A PHYSICIAN OR OTHER HEALTH CARE PROFESSIONAL

• Summary of Benefits

• Coordination of Benefits (COB)

• Member Rights and Responsibilities 

PHARMACY BENEFIT INFORMATION

• PHARMACY BENEFIT INFORMATION

• PHARMACY ENGAGEMENT RESOURCES

VISION INFORMATION

• VISION PLAN WELCOME BROCHURE

• VISION POLICY

• VISION CERTIFICATE

DENTAL INFORMATION

• DENTAL POLICY

• DENTAL CERTIFICATE

• DENTAL OPTIONS PPO

• DENTAL CLAIM FORM

LIFE INSURANCE INFORMATION

• LIFE INSURANCE WELCOME BROCHURE

• LIFE POLICY

• LIFE CERTIFICATE

BEHAVIORAL HEALTH

Virtual Visits

NATIONAL SUICIDE PREVENTION HOTLINE

1-800-273-8255

https://suicidepreventionlifeline.org/

VIRTUAL VISITS

• Virtual Visits $50

• Virtual Visits $0

SUBSTANCE ABUSE

SUBSTANCE ABUSE HELPLINE