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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 (2-99)
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
Checklist - Case Installation (2-99)
UHC branded checklist for Case Installation. Form was created prior to UHC changing SG definition to 99 lives, so employer health addendum is not needed, and employee apps should be the Employee Enrollment form for 2-99.
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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 - Medical Underwriting (2-99)
UHC branded checklist regarding what is needed to submit a quote for medical underwriting review. Please be advised that this is an old form, and UHC will require individual questionnaires through 99 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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