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08.17.2012
Employee Enrollment Form (51-99)
Employee enrollment form to be completed by all enrollment in group health, dental, vision and life products. Medical enrollment does not need to have completed the health questionnaire. Form doubles as waiver.
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08.17.2012
UHC Health Addendum (51-99)
To be completed by groups 51-99 in size, in order to obtain firm rates. Effective August 2012, groups 51-99 will not be individually medically underwritten, rather a group questionnaire will be required.
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06.12.2012
Online Application Process
Simplify the way you collect applications for underwriting! UHC's online MUW tool allows you to safely and accurately collect medical information so you can get your quotes quicker!
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02.17.2012
HIPAA disclosure authorization form
Part of the Medical Underwriting Process; Members will need to complete and sign off on this form in order to submit health questionaires from other carriers. If group enrolls, they must complete the UHC forms.
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02.09.2012
Employee Enrollment Form (2-50)
Employee enrollment form to be completed by all enrollment in group health, dental, vision and life products. Medical enrollment must complete the health questionnaire. Form doubles as waiver.
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11.16.2011
Case Installation Coversheet (2-50)
UHC branded coversheet to be submitted with all SG 2-50 cases. Please remember that all paperwork should be sent through your Account Manager and NOT submitted directly to the UHC address on the form. We have a dedicated service team.
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11.16.2011
Required Tax Documents (2-99)
UHC branded listing of required tax documents depending on size of group. Please be advised that this form was created prior to UHC extending the SG definition to 99, so the documents need through 50 are good through 99.
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11.16.2011
Checklist - Case Installation (2-50)
UHC branded checklist for Case Installation. Form was created prior to UHC changing the need for individual medical udnerwriting for 2-50 lives. A group questionnaire is no longer accepted for 20-50 lives.
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11.16.2011
Common Ownership form
UHC branded form to be completed by an officer, lawyer, or accountant, if an Employer wishes to enroll 2+ companies which are commonly owned as 1 health plan.
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11.16.2011
HRA Benefit Form
UHC branded form to be completed by Employer, when they are funding an HRA account for their employees. This form is how they elect how the plan will distribute funds, how much per employee, and if rollover.
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