| Form Name | Effective Date | Download Form |
|---|---|---|
|
New Group Submission |
||
|
New Business Checklist |
10/01/2024 | Download |
|
Employer Application for Small Business |
12/01/2024 | Download |
|
Employer Application for Standalone Dental & Vision |
01/01/2022 | Download |
|
Employer Application for Small Group Life and Disability |
01/01/2022 | Download |
|
Product and Benefit Selection Form |
12/01/2024 | Download |
|
Direct Debit Authorization Form |
04/01/2024 | Download |
|
Participation & Floor Certification Form (for groups situs in California) |
07/01/2022 | Download |
|
Participation & Floor Certification Form (for groups situs outside of California) |
06/01/2022 | Download |
|
Common Ownership Certification |
01/01/2020 | Download |
|
In Force Group Forms |
||
|
Group Acceptance/Change Form (GAF) |
12/01/2024 | Download |
|
Group Information Change Form |
01/01/2022 | Download |
|
Employee Open Enrollment Changes Spreadsheet |
01/01/2020 | Download |
|
Employer Group Reporting Form |
01/01/2022 | Download |
|
Plan Year Change Request Form |
01/01/2020 | Download |
|
Administration |
||
|
Employer uhcservices.com Reference Guide |
04/01/2024 | Download |
|
Employer eServices Reference Guide |
08/01/2022 | Download |
|
Employer eServices Online Renewal Quick Reference Guide |
08/01/2022 | Download |
|
Employer eServices Login Help |
01/01/2020 | Download |
|
Employer eServices Website Tips |
01/01/2020 | Download |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
Enrollment and Change Forms |
||
|
Employee Application |
10/01/2023 | Download |
|
Employee Application - Standalone Dental & Vision |
01/01/2022 | Download |
|
Employee Application - Life and Disability |
01/01/2022 | Download |
|
Employee - Statement of Dependent Eligibility Beyond Limiting Age Due to Mental or Physical Disability |
01/01/2020 | Download |
|
Life Beneficiary Form |
01/01/2022 | Download |
|
Transition of Care Form |
01/01/2020 | Download |
|
Claim Forms |
||
|
Authorization for the Release of Health Information |
04/01/2024 | Download |
|
Medical Claim Form |
08/01/2022 | Download |
|
International Claim Form |
08/01/2022 | Download |
|
Pharmacy Claim Form |
08/01/2022 | Download |
|
Mail Order Pharmacy Form |
04/01/2024 | Download |
|
Dental Claim Form |
04/01/2024 | Download |
|
Vision Claim Form (out of network reimbursement) |
04/01/2024 | Download |
| Form Name | Effective Date | Download Form | |
|---|---|---|---|
|
2024 Medical HMO Choice Simplified |
|||
|
Signature HMO Network |
|||
|
Signature Platinum 25-50/10% w/Core Rewards (CW-X6) |
01/01/2024 | Summary | SBC |
|
Signature Platinum 25-50/20% w/Core Rewards (DI-O2) |
01/01/2024 | Summary | SBC |
|
Signature Platinum 20-40/300d w/Core Rewards (CW-XY) |
01/01/2024 | Summary | SBC |
|
Signature Platinum 25-50/400d w/Core Rewards (CW-X3) |
01/01/2024 | Summary | SBC |
|
Signature Gold 35-70/20%/500ded w/Core Rewards (CW-YF) |
01/01/2024 | Summary | SBC |
|
Signature Gold 35-70/600d w/Core Rewards (DI-O5) |
01/01/2024 | Summary | SBC |
|
Signature Gold 35-70/700d w/Core Rewards (CW-YC) |
01/01/2024 | Summary | SBC |
|
Signature Gold 35-70/25%/1250ded w/Core Rewards (DI-O8) |
01/01/2024 | Summary | SBC |
|
Signature Silver 60-95/40%/2400ded w/Core Rewards (DI-PA) |
01/01/2024 | Summary | SBC |
|
Alliance HMO Network |
|||
|
Alliance Platinum 25-50/10% w/Core Rewards (CW-X7) |
01/01/2024 | Summary | SBC |
|
Alliance Platinum 25-50/20% w/Core Rewards (DI-O3) |
01/01/2024 | Summary | SBC |
|
Alliance Platinum 20-40/300d w/Core Rewards (CW-XZ) |
01/01/2024 | Summary | SBC |
|
Alliance Platinum 25-50/400d w/Core Rewards (CW-X4) |
01/01/2024 | Summary | SBC |
|
Alliance Gold 35-70/20%/500ded w/Core Rewards (CW-YG) |
01/01/2024 | Summary | SBC |
|
Alliance Gold 35-70/600d w/Core Rewards (DI-O6) |
01/01/2024 | Summary | SBC |
|
Alliance Gold 35-70/700d w/Core Rewards (CW-YD) |
01/01/2024 | Summary | SBC |
|
Alliance Gold 35-70/25%/1250ded w/Core Rewards (DI-O9) |
01/01/2024 | Summary | SBC |
|
Alliance Silver 60-95/40%/2400ded w/Core Rewards (DI-PC) |
01/01/2024 | Summary | SBC |
|
Harmony HMO Network |
|||
|
Harmony Platinum 25-50/10% w/Core Rewards (CW-X5) |
01/01/2024 | Summary | SBC |
|
Harmony Platinum 25-50/10% Canopy w/Core Rewards (CW-X5) |
01/01/2024 | Summary | SBC |
|
Harmony Platinum 25-50/20% w/Core Rewards (DI-OZ) |
01/01/2024 | Summary | SBC |
|
Harmony Platinum 25-50/20% Canopy w/Core Rewards (DI-OZ) |
01/01/2024 | Summary | SBC |
|
Harmony Platinum 20-40/300d w/Core Rewards (CW-XX) |
01/01/2024 | Summary | SBC |
|
Harmony Platinum 20-40/300d Canopy w/Core Rewards (CW-XX) |
01/01/2024 | Summary | SBC |
|
Harmony Platinum 25-50/400d w/Core Rewards (CW-X2) |
01/01/2024 | Summary | SBC |
|
Harmony Platinum 25-50/400d Canopy w/Core Rewards (CW-X2) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/20%/500ded w/Core Rewards (CW-YE) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/20%/500ded Canopy w/Core Rewards (CW-YE) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/600d w/Core Rewards (DI-O4) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/600d Canopy w/Core Rewards (DI-O4) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/700d w/Core Rewards (CW-YB) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/700d Canopy w/Core Rewards (CW-YB) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/25%/1250ded w/Core Rewards (DI-O7) |
01/01/2024 | Summary | SBC |
|
Harmony Gold 35-70/25%/1250ded Canopy w/Core Rewards (DI-O7) |
01/01/2024 | Summary | SBC |
|
Harmony Silver 60-95/40%/2400ded w/Core Rewards (DI-PB) |
01/01/2024 | Summary | SBC |
|
Harmony Silver 60-95/40%/2400ded Canopy w/Core Rewards (DI-PB) |
01/01/2024 | Summary | SBC |
|
Harmony Silver 40%/2400ded w/Core Rewards (DI-PD) |
01/01/2024 | Summary | SBC |
|
Harmony Silver 40%/2400ded Canopy w/Core Rewards (DI-PD) |
01/01/2024 | Summary | SBC |
|
2024 Medical PPO Choice Simplified |
|||
|
Select Plus PPO Network |
|||
|
Select Plus Platinum 15/10% w/Core Rewards (DH-98) |
01/01/2024 | Summary | SBC |
|
Select Plus Platinum 15/250/10% w/Core Rewards (DI-AE) |
01/01/2024 | Summary | SBC |
|
Select Plus Platinum 15/250/20% w/Core Rewards (DH-99) |
01/01/2024 | Summary | SBC |
|
Select Plus Platinum 5/250/20% w/Core Rewards and Care Cash (DI-AC) |
01/01/2024 | Summary | SBC |
|
Select Plus Gold 25/30% w/Core Rewards (DI-AD) |
01/01/2024 | Summary | SBC |
|
Select Plus Gold 30/500/20% w/Core Rewards (DI-AF) |
01/01/2024 | Summary | SBC |
|
Select Plus Gold 30/1000/20% w/Core Rewards and Care Cash (DH-9T) |
01/01/2024 | Summary | SBC |
|
Select Plus Gold 10/1500/30% w/Core Rewards and Care Cash (DI-AJ) |
01/01/2024 | Summary | SBC |
|
Select Plus Silver 55/1950/40% w/Core Rewards and Care Cash (DI-AG) |
01/01/2024 | Summary | SBC |
|
Select Plus Silver 55/2450/40% w/Core Rewards and Care Cash (DI-AH) |
01/01/2024 | Summary | SBC |
|
Select Plus Silver HDHP 2800/40% w/Premium Rewards (DI-AB) |
01/01/2024 | Summary | SBC |
|
Select Plus Bronze 6000/40% w/Premium Rewards and Care Cash (DI-AA) |
01/01/2024 | Summary | SBC |
|
Select Plus Bronze 7500/50% w/Premium Rewards and Care Cash (DH-9Q) |
01/01/2024 | Summary | SBC |
|
Select Plus Bronze HDHP 6000/40% w/Premium Rewards (DI-AI) |
01/01/2024 | Summary | SBC |
|
Core PPO Network |
|||
|
Core Platinum 15/10% w/Core Rewards (DH-9V) |
01/01/2024 | Summary | SBC |
|
Core Platinum 15/250/10% w/Core Rewards (DH-93) |
01/01/2024 | Summary | SBC |
|
Core Platinum 15/250/20% w/Core Rewards (DH-9W) |
01/01/2024 | Summary | SBC |
|
Core Platinum 5/250/20% w/Core Rewards and Care Cash (DH-9Z) |
01/01/2024 | Summary | SBC |
|
Core Gold 25/30% w/Core Rewards (DH-92) |
01/01/2024 | Summary | SBC |
|
Core Gold 30/500/20% w/Core Rewards (DH-94) |
01/01/2024 | Summary | SBC |
|
Core Gold 30/1000/20% w/Core Rewards and Care Cash (DH-9S) |
01/01/2024 | Summary | SBC |
|
Core Gold 10/1500/30% w/Core Rewards and Care Cash (DH-9U) |
01/01/2024 | Summary | SBC |
|
Core Silver 55/1950/40% w/Core Rewards and Care Cash (DH-95) |
01/01/2024 | Summary | SBC |
|
Core Silver 55/2450/40% w/Core Rewards and Care Cash (DH-96) |
01/01/2024 | Summary | SBC |
|
Core Silver HDHP 2800/40% w/Premium Rewards (DH-9Y) |
01/01/2024 | Summary | SBC |
|
Core Bronze 6000/40% w/Premium Rewards and Care Cash (DH-9X) |
01/01/2024 | Summary | SBC |
|
Core Bronze 7500/50% w/Premium Rewards and Care Cash (DH-9P) |
01/01/2024 | Summary | SBC |
|
Core Bronze HDHP 6000/40% w/Premium Rewards (DH-97) |
01/01/2024 | Summary | SBC |
|
2024 Medical HMO State Package |
|||
|
Alliance HMO Network |
|||
|
State Alliance Platinum 90 HMO 0/15 (CE-OK) |
01/01/2024 | Summary | SBC |
|
State Alliance Gold 80 HMO 350/25 (CE-OL) |
01/01/2024 | Summary | SBC |
|
State Alliance Silver 70 HMO 2500/55 (CW-YO) |
01/01/2024 | Summary | SBC |
|
2024 Medical EPO State Package |
|||
|
Navigate EPO Network |
|||
|
State Navigate Platinum 15/10% (DI-KC) |
01/01/2024 | Summary | SBC |
|
State Navigate Gold 25/350/20% (DI-KD) |
01/01/2024 | Summary | SBC |
|
State Navigate Silver 55/2500/35% (DI-KF) |
01/01/2024 | Summary | SBC |
|
State Navigate Bronze 60/6300/40% (DH-9R) |
01/01/2024 | Summary | SBC |
|
2024 Medical PPO State Package |
|||
|
Core PPO Network |
|||
|
State Core Platinum 15/10% (DI-KB) |
01/01/2024 | Summary | SBC |
|
State Core Gold 25/350/20% (DI-KA) |
01/01/2024 | Summary | SBC |
|
State Core Silver 55/2500/35% (DI-J9) |
01/01/2024 | Summary | SBC |
|
State Core Bronze 60/6300/40% (DH-9N) |
01/01/2024 | Summary | SBC |
|
2024 Non-Differential PPO - for employees residing outside a Select Plus or Core service area |
|||
|
Non-Differential PPO Silver 2250/30% w/Core Rewards (DH-9O) |
01/01/2024 | Summary | SBC |
|
2023 Medical HMO Choice Simplified |
|||
|
Signature HMO Network |
|||
|
Signature Platinum 20-40/300d (CW-XY) |
01/01/2023 | Summary | SBC |
|
Signature Platinum 25-50/10% (CW-X6) |
01/01/2023 | Summary | SBC |
|
Signature Platinum 25-50/20% (CP-SM) |
01/01/2023 | Summary | SBC |
|
Signature Platinum 25-50/400d (CW-X3) |
01/01/2023 | Summary | SBC |
|
Signature Gold 35-70/20%/500ded (CW-YF) |
01/01/2023 | Summary | SBC |
|
Signature Gold 35-70/600d (CW-X9) |
01/01/2023 | Summary | SBC |
|
Signature Gold 35-70/700d (CW-YC) |
01/01/2023 | Summary | SBC |
|
Signature Gold 35-70/30%/1500ded (CW-YI) |
01/01/2023 | Summary | SBC |
|
Signature Silver 60-95/40%/2400ded (CW-YK) |
01/01/2023 | Summary | SBC |
|
Alliance HMO Network |
|||
|
Alliance Platinum 20-40/300d (CW-XZ) |
01/01/2023 | Summary | SBC |
|
Alliance Platinum 25-50/10% (CW-X7) |
01/01/2023 | Summary | SBC |
|
Alliance Platinum 25-50/20% (CP-SU) |
01/01/2023 | Summary | SBC |
|
Alliance Platinum 25-50/400d (CW-X4) |
01/01/2023 | Summary | SBC |
|
Alliance Gold 35-70/20%/500ded (CW-YG) |
01/01/2023 | Summary | SBC |
|
Alliance Gold 35-70/600d (CW-YA) |
01/01/2023 | Summary | SBC |
|
Alliance Gold 35-70/700d (CW-YD) |
01/01/2023 | Summary | SBC |
|
Alliance Gold 35-70/30%/1500ded (CW-YJ) |
01/01/2023 | Summary | SBC |
|
Alliance Silver 60-95/40%/2400ded (CW-YM) |
01/01/2023 | Summary | SBC |
|
Harmony HMO Network |
|||
|
Harmony Platinum 20-40/300d (CW-XX) |
01/01/2023 | Summary | SBC |
|
Harmony Platinum 20-40/300d Canopy (CW-XX) |
01/01/2023 | Summary | SBC |
|
Harmony Platinum 25-50/10% (CW-X5) |
01/01/2023 | Summary | SBC |
|
Harmony Platinum 25-50/10% Canopy (CW-X5) |
01/01/2023 | Summary | SBC |
|
Harmony Platinum 25-50/20% (CP-SG) |
01/01/2023 | Summary | SBC |
|
Harmony Platinum 25-50/20% Canopy (CP-SG) |
01/01/2023 | Summary | SBC |
|
Harmony Platinum 25-50/400d (CW-X2) |
01/01/2023 | Summary | SBC |
|
Harmony Platinum 25-50/400d Canopy (CW-X2) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/20%/500ded (CW-YE) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/20%/500ded Canopy (CW-YE) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/600d (CW-X8) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/600d Canopy (CW-X8) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/700d (CW-YB) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/700d Canopy (CW-YB) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/30%/1500ded (CW-YH) |
01/01/2023 | Summary | SBC |
|
Harmony Gold 35-70/30%/1500ded Canopy (CW-YH) |
01/01/2023 | Summary | SBC |
|
Harmony Silver 40%/2400ded (CW-YN) |
01/01/2023 | Summary | SBC |
|
Harmony Silver 40%/2400ded Canopy (CW-YN) |
01/01/2023 | Summary | SBC |
|
Harmony Silver 60-95/40%/2400ded (CW-YL) |
01/01/2023 | Summary | SBC |
|
Harmony Silver 60-95/40%/2400ded Canopy (CW-YL) |
01/01/2023 | Summary | SBC |
|
2023 Medical PPO Choice Simplified |
|||
|
Select Plus PPO Network |
|||
|
Select Plus Platinum 15/10% (CV-QN) |
01/01/2023 | Summary | SBC |
|
Select Plus Platinum 15/250/10% (CV-QT) |
01/01/2023 | Summary | SBC |
|
Select Plus Platinum 15 250 20% (CV-QO) |
01/01/2023 | Summary | SBC |
|
Select Plus Platinum 5/250/20% (CV-QR) |
01/01/2023 | Summary | SBC |
|
Select Plus Gold 30/30% (CV-QS) |
01/01/2023 | Summary | SBC |
|
Select Plus Gold 35/500/20% (CV-QU) |
01/01/2023 | Summary | SBC |
|
Select Plus Gold 35/1000/20% (CV-QV) |
01/01/2023 | Summary | SBC |
|
Select Plus Gold 5/1500/30% (CV-QZ) |
01/01/2023 | Summary | SBC |
|
Select Plus Silver 55/1950/40% (CV-QW) |
01/01/2023 | Summary | SBC |
|
Select Plus Silver 55/2450/40% (CV-QX) |
01/01/2023 | Summary | SBC |
|
Select Plus Bronze 5500/40% w/Prem Rewards (CV-QP) |
01/01/2023 | Summary | SBC |
|
Select Plus Bronze 7500/50% w/Care Cash (CV-2P) |
01/01/2023 | Summary | SBC |
|
Select Plus Bronze 7500/50% w/Prem Rewards (CV-PU) |
01/01/2023 | Summary | SBC |
|
Select Plus Silver HDHP w/Prem Rewards 2800/40% (CV-QQ) |
01/01/2023 | Summary | SBC |
|
Select Plus Bronze HDHP w/Prem Rewards 6000/40% (CV-QY) |
01/01/2023 | Summary | SBC |
|
Core PPO Network |
|||
|
Core Platinum 15/10% (CV-QA) |
01/01/2023 | Summary | SBC |
|
Core Platinum 15/250/10% (CV-QG) |
01/01/2023 | Summary | SBC |
|
Core Platinum 15/250/20% (CV-QB) |
01/01/2023 | Summary | SBC |
|
Core Platinum 5/250/20% (CV-QE) |
01/01/2023 | Summary | SBC |
|
Core Gold 30/30% (CV-QF) |
01/01/2023 | Summary | SBC |
|
Core Gold 35/500/20% (CV-QH) |
01/01/2023 | Summary | SBC |
|
Core Gold 35/1000/20% (CV-QI) |
01/01/2023 | Summary | SBC |
|
Core Gold 5/1500/30% (CV-PV) |
01/01/2023 | Summary | SBC |
|
Core Silver 55/1950/40% (CV-QJ) |
01/01/2023 | Summary | SBC |
|
Core Silver 55/2450/40% (CV-QK) |
01/01/2023 | Summary | SBC |
|
Core Silver HDHP w/Prem Rewards 2800/40% (CV-QD) |
01/01/2023 | Summary | SBC |
|
Core Bronze 5500/40% w/Prem Rewards (CV-QC) |
01/01/2023 | Summary | SBC |
|
Core Bronze 7500/50% w/Care Cash (CV-2O) |
01/01/2023 | Summary | SBC |
|
Core Bronze 7500/50% w/Prem Rewards (CV-PS) |
01/01/2023 | Summary | SBC |
|
Core Bronze HDHP w/Prem Rewards 6000/40% (CV-QL) |
01/01/2023 | Summary | SBC |
|
2023 Medical EPO Choice Simplified |
|||
|
Doctors Plan Platinum 15/10% (CV-PZ) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Platinum 15/250/10% (CV-QM) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Platinum 15/250/20% (CV-PX) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Platinum 5/250/20% (CV-PY) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Gold 30/30% (CV-P9) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Gold 35/500/20% (CV-P3) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Gold 35/1000/20% (CV-P4) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Gold 5/1500/30% (CV-P5) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Silver 55/1950/40% (CV-P6) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Silver 55/2450/40% (CV-P7) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Silver HDHP w/Prem Rewards 2800/40% (CV-PW) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Bronze 5500/40% w/Prem Rewards (CV-P8) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Bronze 7500/50% w/Prem Rewards (CV-PR) |
01/01/2023 | Summary | SBC |
|
Doctors Plan Bronze HDHP w/Prem Rewards 6000/40% (CV-P2) |
01/01/2023 | Summary | SBC |
|
2023 Medical HMO State Package |
|||
|
Alliance HMO Network |
|||
|
State Alliance Platinum 90 HMO 0/15 (CE-OK) |
01/01/2023 | Summary | SBC |
|
State Alliance Gold 80 HMO 350/25 (CE-OL) |
01/01/2023 | Summary | SBC |
|
State Alliance Silver 70 HMO 2500/55 (CW-YO) |
01/01/2023 | Summary | SBC |
|
2023 Medical EPO State Package |
|||
|
Navigate EPO Network |
|||
|
State Navigate Platinum 15/10% (CD-FB) |
01/01/2023 | Summary | SBC |
|
State Navigate Gold 25/350/20% (CD-FC) |
01/01/2023 | Summary | SBC |
|
State Navigate Silver 55/2500/35% (CU-VI) |
01/01/2023 | Summary | SBC |
|
State Navigate Bronze 65/6300/40% (CD-FE) |
01/01/2023 | Summary | SBC |
|
2023 Medical PPO State Package |
|||
|
Core PPO Network |
|||
|
State Core Platinum 15/10% (CE-MA) |
01/01/2023 | Summary | SBC |
|
State Core Gold 25/350/20% (CE-MB) |
01/01/2023 | Summary | SBC |
|
State Core Silver 55/2500/35% (CV-PT) |
01/01/2023 | Summary | SBC |
|
State Core Bronze 65/6300/40% (CE-MD) |
01/01/2023 | Summary | SBC |
|
2023 Non-Differential PPO - for employees residing outside a Select Plus or Core service area |
|||
|
Non-Differential PPO Silver 2250/30% (CE-MI) |
01/01/2023 | Summary | SBC |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
General Information |
||
|
Product Catalog 1.24 |
01/01/2024 | Download |
|
UHC Sales Placemat |
01/01/2025 | Download |
|
Underwriting Guidelines |
09/01/2024 | Download |
|
Bundled Pricing Flyer (groups of 2 - 100) |
05/01/2024 | Download |
|
COBRA Administration Flyer |
07/01/2023 | Download |
|
COBRA Administration Sell Sheet |
07/01/2023 | Download |
|
COBRA, FSA & Pre-Tax Premium Administration Sell Sheet |
07/01/2023 | Download |
|
COBRA Administration Guide |
07/01/2023 | Download |
|
COBRA, FSA & Pre-Tax Premium Implementation Checklist |
07/01/2023 | Download |
|
Digital Engagement & Tools Flyer |
06/01/2024 | Download |
|
EAP Member Flyer (available to PPO members Only) |
12/01/2023 | Download |
|
Helpful Information & Resources Flyer |
04/01/2024 | Download |
|
Member Welcome Brochure |
02/01/2024 | Download |
|
Packaged Savings Flyer (groups of 2 - 99) |
01/01/2022 | Download |
|
Producer Performance Guide 2024 |
01/01/2024 | Download |
|
Specialty Overview Flyer |
08/01/2023 | Download |
|
Wellness - Behavioral Health Virtual Visits |
02/01/2024 | Download |
|
Wellness - Care Cash Rewards Flyer |
02/01/2024 | Download |
|
Wellness - Premium Rewards Program Flyer |
02/01/2024 | Download |
|
Wellness - Core Rewards Program Flyer |
02/01/2024 | Download |
|
Wellness - One Pass Broker/Employer Flyer (CA Situs Clients) |
01/01/2023 | Download |
|
Wellness - One Pass Member Flyer (CA Situs Clients) |
02/01/2024 | Download |
|
Wellness - Rewards Biometric Screening |
02/01/2024 | Download |
|
Medical |
||
|
Medical Product Grid |
01/01/2025 | Download |
|
Choice Simplified Package |
01/01/2025 | Download |
|
Flu Shot Member Flyer |
10/01/2023 | Download |
|
Flu Shot Clinic Customer Flyer |
10/01/2023 | Download |
|
HSA Best Practices Guide |
08/01/2022 | Download |
|
New Member Checklist |
02/01/2024 | Download |
|
Nurseline Flyer |
01/01/2020 | Download |
|
Online Provider Search Instructions |
02/01/2024 | Download |
|
Selecting a PCP Flyer |
07/01/2023 | Download |
|
Plan Code Reference Tool 2023 |
01/01/2023 | Download |
|
OptumRx Pharmacy Home Delivery Flyer |
02/01/2024 | Download |
|
Preventive Care Medications Pharmacy List |
07/01/2023 | Download |
|
Pharmacy and Medical Integration Brochure |
02/01/2024 | Download |
|
Specialty Pharmacy & Medical Integration Brochure |
07/01/2023 | Download |
|
Standard Select Pharmacy Network with CVS |
11/01/2022 | Download |
|
Standard Select Pharmacy Network with Walgreens |
11/01/2022 | Download |
|
Preventive Care Services Overview |
02/01/2024 | Download |
|
Select Plus PPO PCP Election Flyer |
01/01/2022 | Download |
|
HMO Network Comparison Tool - Small Group |
10/01/2024 | Download |
|
HMO Network Comparison Tool - Large Group |
04/01/2023 | Download |
|
HMO Medical Group Website Links |
01/01/2020 | Download |
|
Advantage HMO Network Flyer |
08/01/2022 | Download |
|
Alliance HMO Network Brochure |
08/01/2022 | Download |
|
Alliance HMO Network List |
11/01/2024 | Download |
|
Harmony HMO Statewide Flyer |
01/01/2024 | Download |
|
Harmony HMO Network List |
11/01/2024 | Download |
|
Harmony Southern California Flyer |
01/01/2024 | Download |
|
Harmony & Canopy HMO Northern California Brochure |
01/01/2024 | Download |
|
Canopy Health Overview Flyer |
02/01/2020 | Download |
|
Select Plus PPO Flyer |
02/01/2020 | Download |
|
Core PPO Brochure |
08/01/2022 | Download |
|
Navigate EPO Brochure |
01/01/2020 | Download |
|
Navigate EPO FAQs |
01/01/2020 | Download |
|
Virtual Visits Overview Flyer |
12/01/2023 | Download |
|
Vital Medications Flyer |
02/01/2024 | Download |
|
Vital Medications Program |
02/01/2024 | Download |
|
Dental |
||
|
Dental Simplified Flyer |
10/01/2023 | Download |
|
Dental Speed to Market Flyer |
10/01/2023 | Download |
|
Dental Combo Flyer - SmileDirect, Dialcare, Jetdental & Quip |
01/01/2022 | Download |
|
Dental & Vision Member Discount Flyer |
01/01/2022 | Download |
|
Dental Consumer MaxMultiplier Flyer |
01/01/2022 | Download |
|
Dental FlexAppeal Enhanced Flyer |
01/01/2022 | Download |
|
How to Search for a UHC Dental or Vision Provider |
08/01/2022 | Download |
|
SmileDirectClub FAQ |
08/01/2022 | Download |
|
SmileDirectClub Employer Flyer |
08/01/2022 | Download |
|
SmileDirectClub PPO Member Flyer |
08/01/2022 | Download |
|
Virtual Dental Visits Flyer - Teledentistry |
01/01/2022 | Download |
|
Vision |
||
|
Vision Simplified Flyer |
01/01/2022 | Download |
|
Vision Provider Network Flyer |
02/01/2024 | Download |
|
EyeSafe Flyer |
08/01/2022 | Download |
|
EyeSafe Dell Discount Flyer |
01/01/2022 | Download |
|
Express Exam Flyer |
02/01/2024 | Download |
|
Hearing Discounts Through UHC Vision Flyer |
09/01/2022 | Download |
|
How to Print Your Vision ID Card |
08/01/2022 | Download |
|
Laser Vision Correction Flyer |
01/01/2022 | Download |
|
Lens Formularies Flyer [effective 5/1/2021] |
08/01/2022 | Download |
|
Lens Options Flyer |
02/01/2024 | Download |
|
Member Welcome Brochure |
02/01/2024 | Download |
|
Vision Benefits at Warby Parker |
02/01/2024 | Download |
|
Vision FAQs |
08/01/2022 | Download |
|
Vision Coverage Overview |
02/01/2024 | Download |
|
Life & Disability |
||
|
Life Insurance Administration Guide |
04/01/2024 | Download |
|
Life Benefits Overview |
08/01/2022 | Download |
|
Life Quick Reference Guide |
08/01/2022 | Download |
|
Life Member Welcome Guide |
08/01/2022 | Download |
|
Combined Life and Value Added Services Flyer |
09/01/2022 | Download |
|
Disability Quick Reference Guide |
02/01/2024 | Download |
|
Disability Insurance Administration Guide |
04/01/2024 | Download |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
Medical Rate Guides |
||
|
Q2 2024 |
||
|
Medical Rate Guide Signature Value HMO [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
Medical Rate Guide Harmony HMO [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
Medical Rate Guide Alliance HMO [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
Medical Rate Guide Navigate [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
Medical Rate Guide PPO [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
Q1 2024 |
||
|
Medical Rate Guide Signature Value HMO [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
Medical Rate Guide Harmony HMO [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
Medical Rate Guide Alliance HMO [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
Medical Rate Guide Navigate [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
Medical Rate Guide PPO [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
Ancillary Rate Guides |
||
|
Q2 2024 |
||
|
DHMO Dental Rate Card - California [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
PPO Dental Rate Card - Southern California [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
PPO Dental Rate Card - Northern California [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
PPO Dental Rate Card - San Francisco Metro [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
Small Business Vision Card - California [effective 4/1/2024 to 6/1/2024] |
04/01/2024 | Download |
|
Q1 2024 |
||
|
DHMO Dental Rate Card - California [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
PPO Dental Rate Card - Southern California [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
PPO Dental Rate Card - Northern California [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
PPO Dental Rate Card - San Francisco Metro [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
|
Small Business Vision Card - California [effective 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
