RESOURCE CENTER

Installation Forms
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Member Level Census Template
Beginning 6/1/16, UHC will require member level data (employees and dependents) including first name, last name, date of birth, and home zip code for any all saver quotes for groups with 20+ enrolled. This is the suggested census template.
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All Saver - 2014 Employee Packet for Small Business (10-99)
UHC branded installation form to be completed by employee for new 10-99 eligible business.
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All Saver - 2014 Employer Packet for Small Business (10-99)
UHC branded installation form to be completed by employer for new 10-99 eligible business.
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All Saver - 2014 Application for Excess Loss Insurance
Specific to All Saver applicants, this form is mandatory as part of the alternative funding arrangement due to nature of the All Saver product.
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2014 PA Health Addendum (51-99)
To be completed by groups 51-99 in size, in order to obtain firm rates. Groups 51-99 will not be individually medically underwritten, rather a group questionnaire will be required.
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2014 Sold Case Checklist (PA 51-99)
This is a step by step checklist for a sold case, including timing of submissions, where to send paperwork, where to send check, and a brief checklist of required paperwork. Please send all paperwork to your B&B account manager.
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08.18.2014
Employee Enrollment Spreadsheet for 51-99 (EXCEL)
For larger groups, we can process enrollment via an Excel census enrollment. This sample is how information should be formated so UHC can properly upload the information.
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2014 Sold Case Checklist (PA 2-50)
This is a step by step checklist for a sold case, including timing of submissions, where to send paperwork, where to send check, and a brief checklist of required paperwork. Please send all paperwork to your B&B account manager.
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2014 Checklist - Case Installation (PA 2-50)
UHC branded checklist for Case Installation. This form must be submitted with ALL new business 2-50 submissions. Please send all paperwork to your B&B Account Manager.
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2014 Employee Enrollment Form (2-99)
Employee enrollment form to be completed by all enrollment in group health, dental, vision and life products. Form doubles as waiver.
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2014 Employer Application for Small Business (2-99)
UHC branded installation form to be completed by employer for new 2-99 eligible business.
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Required Tax Documents - Checklist
Listing of required tax documents whether your client is a C-corporation, S-corporation, Sole Proprietor, Partnership, LLC, or contain 1099 employees.
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09.24.2012
United Healthcare BOR letter
Sample of Broker of Record letter to be used for existing UHC clients. No other version will be acceptable.
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