UnitedHealthcare

UnitedHealthcare is an operating division of UnitedHealth Group, the largest single health carrier in the United States. As a recognized leader in the health and well-being industry, we strive to improve the quality and effectiveness of health care for all Americans, enhance access to health benefits, creative products and services that make health care more affordable, and use technology to make the health care system easier to navigate.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
New Business Checklist
01/01/2020 Download
Employer Application for Small Business
01/01/2020 Download
Employer Application for Standalone Dental & Vision
01/01/2020 Download
Employer Application for Small Group Life and Disability
01/01/2020 Download
Product and Benefit Selection Form 7.21
07/01/2021 Download
Product and Benefit Selection Form 1.22
01/01/2022 Download
Direct Debit Form - use with Medical HMO Only Groups
04/01/2021 Download
Direct Debit Form - use with Medical HMO & PPO Dual Option Groups with Ancillary
04/01/2021 Download
Direct Debit Form - use with Medical HMO & PPO Dual Option Groups
04/01/2021 Download
Participation & Floor Certification Form (for groups with 10 or more employees)
01/01/2020 Download
Common Ownership Certification
01/01/2020 Download
In Force Group Forms
Group Acceptance/Change Form (GAF) 7.21
07/01/2021 Download
Group Acceptance/Change Form (GAF) 1.22
01/01/2022 Download
Group Information Change Form
04/01/2021 Download
Employee Open Enrollment Changes Spreadsheet
01/01/2020 Download
Employer Group Reporting Form
01/01/2020 Download
Plan Year Change Request Form
01/01/2020 Download
Termination Request Form
01/01/2022 Download
Administration
Employer Administration Guide Medical
01/01/2020 Download
Employer eServices Reference Guide
01/01/2020 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
08/01/2020 Download
Employee Application - Standalone Dental & Vision
01/01/2020 Download
Employee Application - Life and Disability
01/01/2020 Download
Employee - Statement of Dependent Eligibility Beyond Limiting Age Due to Mental or Physical Disability
01/01/2020 Download
Life Beneficiary Form
01/01/2020 Download
Transition of Care Form
01/01/2020 Download
Claim Forms
Authorization for the Release of Health Information
01/01/2020 Download
Medical Claim Form
01/01/2020 Download
International Claim Form
01/01/2020 Download
Pharmacy Claim Form
01/01/2020 Download
Mail Order Pharmacy Form
01/01/2020 Download
Dental Claim Form
01/01/2020 Download
Vision Claim Form (out of network reimbursement)
01/01/2020 Download
Form Name Effective Date Download Form
2022 Choice Simplified Packages - refer to the guide below to confirm allowed plan pairings
Choice Simplified Packages 1.22
01/01/2022 Summary
2022 Medical HMO Choice Simplified
Signature HMO Network
Signature Platinum 20-40/400d (CP-SK)
01/01/2022 Summary SBC
Signature Platinum 25-50/20% (CP-SM)
01/01/2022 Summary SBC
Signature Platinum Primary Advantage 0-80/20% (CP-SL)
01/01/2022 Summary SBC
Signature Gold 35-70/800d (CP-SN)
01/01/2022 Summary SBC
Signature Gold 35-70/20%/500ded (CP-SO)
01/01/2022 Summary SBC
Signature Gold 35-70/30%/1250ded (CP-SQ)
01/01/2022 Summary SBC
Signature Gold Primary Advantage 0-85/40%/2000ded (CP-SP)
01/01/2022 Summary SBC
Signature Silver 55-95/40%/2350ded (CP-SR)
01/01/2022 Summary SBC
Alliance HMO Network
Alliance Platinum 20-40/400d (CP-ST)
01/01/2022 Summary SBC
Alliance Platinum 25-50/20% (CP-SU)
01/01/2022 Summary SBC
Alliance Platinum Primary Advantage 0-80/20% (CP-S2)
01/01/2022 Summary SBC
Alliance Gold 35-70/800d (CP-SV)
01/01/2022 Summary SBC
Alliance Gold 35-70/20%/500ded (CP-SW)
01/01/2022 Summary SBC
Alliance Gold 35-70/30%/1250ded (CP-SX)
01/01/2022 Summary SBC
Alliance Gold Primary Advantage 0-85/40%/2000ded (CP-S3)
01/01/2022 Summary SBC
Alliance Silver 55-95/40%/2350ded (CP-SY)
01/01/2022 Summary SBC
Harmony HMO Network
Harmony Platinum 20-40/400d (CP-SF)
01/01/2022 Summary SBC
Harmony Platinum 20-40/400d Canopy (CP-SF)
01/01/2022 Summary SBC
Harmony Platinum 25-50/20% (CP-SG)
01/01/2022 Summary SBC
Harmony Platinum 25-50/20% Canopy (CP-SG)
01/01/2022 Summary SBC
Harmony Platinum Primary Advantage 0-80/20% (CP-S5)
01/01/2022 Summary SBC
Harmony Platinum Primary Advantage 0-80/20% Canopy (CP-S5)
01/01/2022 Summary SBC
Harmony Gold 35-70/800d (CP-SH)
01/01/2022 Summary SBC
Harmony Gold 35-70/800d Canopy (CP-SH)
01/01/2022 Summary SBC
Harmony Gold 35-70/20%/500ded (CP-SI)
01/01/2022 Summary SBC
Harmony Gold 35-70/20%/500ded Canopy (CP-SI)
01/01/2022 Summary SBC
Harmony Gold 35-70/30%/1250ded (CP-SJ)
01/01/2022 Summary SBC
Harmony Gold 35-70/30%/1250ded Canopy (CP-SJ)
01/01/2022 Summary SBC
Harmony Gold Primary Advantage 0-85/40%/2000ded (CP-S4)
01/01/2022 Summary SBC
Harmony Gold Primary Advantage 0-85/40%/2000ded Canopy (CP-S4)
01/01/2022 Summary SBC
Harmony Silver 40%/2350ded (CP-SZ)
01/01/2022 Summary SBC
Harmony Silver 40%/2350ded Canopy (CP-SZ)
01/01/2022 Summary SBC
Harmony Silver 55-95/40%/2350ded (CP-SS)
01/01/2022 Summary SBC
Harmony Silver 55-95/40%/2350ded Canopy (CP-SS)
01/01/2022 Summary SBC
2022 Medical PPO Choice Simplified
Select Plus PPO Network
Select Plus Platinum 15/10% (CO-9Y)
01/01/2022 Summary SBC
Select Plus Platinum 15/250/20% (CO-9Z)
01/01/2022 Summary SBC
Select Plus Platinum Primary Advantage 250/20% (CO-92)
01/01/2022 Summary SBC
Select Plus Gold 30/30% (CP-AF)
01/01/2022 Summary SBC
Select Plus Gold 35/500/20% (CP-AG)
01/01/2022 Summary SBC
Select Plus Gold 35/1000/20% (CP-AH)
01/01/2022 Summary SBC
Select Plus Gold Primary Advantage 1500/30% (CP-AI)
01/01/2022 Summary SBC
Select Plus Silver 55/1950/40% (CP-AJ)
01/01/2022 Summary SBC
Select Plus Silver 55/2350/40% (CP-AK)
01/01/2022 Summary SBC
Select Plus Silver HDHP w/Motion 2700/40% (CO-93)
01/01/2022 Summary SBC
Select Plus Bronze 5000/40% (CO-94)
01/01/2022 Summary SBC
Select Plus Bronze 7200/50% (CP-WQ)
01/01/2022 Summary SBC
Select Plus Bronze HDHP w/Motion 6000/40% (CP-AR)
01/01/2022 Summary SBC
Core PPO Network
Core Platinum 15/10% (CO-95)
01/01/2022 Summary SBC
Core Platinum 15/250/20% (CO-96)
01/01/2022 Summary SBC
Core Platinum Primary Advantage 250/20% (CO-97)
01/01/2022 Summary SBC
Core Gold 30/30% (CP-AL)
01/01/2022 Summary SBC
Core Gold 35/500/20% (CP-AM)
01/01/2022 Summary SBC
Core Gold 35/1000/20% (CP-AN)
01/01/2022 Summary SBC
Core Gold Primary Advantage 1500/30% (CP-AO)
01/01/2022 Summary SBC
Core Silver 55/1950/40% (CP-AP)
01/01/2022 Summary SBC
Core Silver 55/2350/40% (CP-AQ)
01/01/2022 Summary SBC
Core Silver HDHP w/Motion 2700/40% (CO-98)
01/01/2022 Summary SBC
Core Bronze 5000/40% (CO-99)
01/01/2022 Summary SBC
Core Bronze 7200/50% (CP-WR)
01/01/2022 Summary SBC
Core Bronze HDHP w/Motion 6000/40% (CP-AS)
01/01/2022 Summary SBC
2022 Medical EPO Choice Simplified
Doctors Plan Platinum 15/10% (CP-AA)
01/01/2022 Summary SBC
Doctors Plan Platinum 15/250/20% (CP-AB)
01/01/2022 Summary SBC
Doctors Plan Platinum Primary Advantage 250/20% (CP-AC)
01/01/2022 Summary SBC
Doctors Plan Gold 30/30% (CP-J3)
01/01/2022 Summary SBC
Doctors Plan Gold 35/500/20% (CP-J4)
01/01/2022 Summary SBC
Doctors Plan Gold 35/1000/20% (CP-J5)
01/01/2022 Summary SBC
Doctors Plan Gold Primary Advantage 1500/30% (CP-J6)
01/01/2022 Summary SBC
Doctors Plan Silver 55/1950/40% (CP-J7)
01/01/2022 Summary SBC
Doctors Plan Silver 55/2350/40% (CP-J8)
01/01/2022 Summary SBC
Doctors Plan Silver HDHP w/Motion 2700/40% (CP-AD)
01/01/2022 Summary SBC
Doctors Plan Bronze 5000/40% (CP-AE)
01/01/2022 Summary SBC
Doctors Plan Bronze 7200/50% (CP-WS)
01/01/2022 Summary SBC
Doctors Plan Bronze HDHP w/Motion 6000/40% (CP-AT)
01/01/2022 Summary SBC
2022 Medical HMO State Package
Harmony HMO Network
State Harmony Silver 30%/2250ded (CE-OB)
01/01/2022 Summary SBC
State Harmony Silver 30%/2250ded Canopy (CE-OB)
01/01/2022 Summary SBC
Alliance HMO Network
State Alliance Platinum 90 HMO 0/15 (CE-OK)
01/01/2022 Summary SBC
State Alliance Gold 80 HMO 350/25 (CE-OL)
01/01/2022 Summary SBC
State Alliance Silver 70 HMO 2250/50 (CE-OM)
01/01/2022 Summary SBC
2022 Medical EPO State Package
Navigate EPO Network
State Navigate Platinum 15/10% (CD-FB)
01/01/2022 Summary SBC
State Navigate Gold 25/350/20% (CD-FC)
01/01/2022 Summary SBC
State Navigate Silver 50/2250/30% (CD-FD)
01/01/2022 Summary SBC
State Navigate Bronze 65/6300/40% (CD-FE)
01/01/2022 Summary SBC
2022 Medical PPO State Package
Core PPO Network
State Core Platinum 15/10% (CE-MA)
01/01/2022 Summary SBC
State Core Gold 25/350/20% (CE-MB)
01/01/2022 Summary SBC
State Core Silver 50/2250/30% (CE-MC)
01/01/2022 Summary SBC
State Core Bronze 65/6300/40% (CE-MD)
01/01/2022 Summary SBC
2022 Non-Differential PPO - for employees residing outside a Select Plus or Core service area
Non-Differential PPO Silver 2250/30% (CE-MI)
01/01/2022 Summary SBC
2021 Choice Simplified Packages- refer to the guide below to confirm allowed plan pairings
Choice Simplified Packages 7.21
07/01/2021 Summary
2021 Medical HMO Choice Simplified
Signature HMO Network
Signature Platinum Primary Advantage 0-80/20% (CE-NM)
01/01/2021 Summary SBC
Signature Platinum 20-40/20% (CE-NN)
01/01/2021 Summary SBC
Signature Platinum 20-40/400d (CE-NL)
01/01/2021 Summary SBC
Signature Gold 30-70/20%/500ded (CE-NP)
01/01/2021 Summary SBC
Signature Gold 30-70/800d (CE-NO)
01/01/2021 Summary SBC
Signature Gold 30-70/30%/1250ded (CE-NR)
01/01/2021 Summary SBC
Signature Gold Primary Advantage 0-90/30%/1750ded (CE-NQ)
01/01/2021 Summary SBC
Signature Silver 50-90/40%/2250ded (CE-NS)
01/01/2021 Summary SBC
Advantage HMO Network
Advantage Platinum Primary Advantage 0-80/20% (CE-NU)
01/01/2021 Summary SBC
Advantage Platinum 20-40/20% (CE-NV)
01/01/2021 Summary SBC
Advantage Platinum 20-40/400d (CE-NT)
01/01/2021 Summary SBC
Advantage Gold 30-70/20%/500ded (CE-NX)
01/01/2021 Summary SBC
Advantage Gold 30-70/800d (CE-NW)
01/01/2021 Summary SBC
Advantage Gold 30-70/30%/1250ded (CE-NZ)
01/01/2021 Summary SBC
Advantage Gold Primary Advantage 0-90/30%/1750ded (CE-NY)
01/01/2021 Summary SBC
Advantage Silver 50-90/40%/2250ded (CE-N2)
01/01/2021 Summary SBC
Alliance HMO Network
Alliance Platinum 20-40/20% (CE-OE)
01/01/2021 Summary SBC
Alliance Platinum 20-40/400d (CE-OC)
01/01/2021 Summary SBC
Alliance Gold 30-70/20%/500ded (CE-OG)
01/01/2021 Summary SBC
Alliance Gold 30-70/800d (CE-OF)
01/01/2021 Summary SBC
Alliance Gold 30-70/30%/1250ded (CE-OI)
01/01/2021 Summary SBC
Alliance Silver 50-90/40%/2250ded (CE-OJ)
01/01/2021 Summary SBC
Harmony HMO Network
Harmony Platinum 20-40/20% (CE-N5)
01/01/2021 Summary SBC
Harmony Platinum 20-40/400d (CE-N3)
01/01/2021 Summary SBC
Harmony Gold 30-70/20%/500ded (CE-N7)
01/01/2021 Summary SBC
Harmony Gold 30-70/800d (CE-N6)
01/01/2021 Summary SBC
Harmony Gold 30-70/30%/1250ded (CE-N9)
01/01/2021 Summary SBC
Harmony Silver 30%/2250ded (CE-OB)
01/01/2021 Summary SBC
Harmony Silver 50-90/40%/2250ded (CE-OA)
01/01/2021 Summary SBC
2021 Medical PPO Choice Simplified
Select Plus PPO Network
Select Plus Platinum 15/10% (CE-MJ)
01/01/2021 Summary SBC
Select Plus Platinum Primary Advantage 250/20% (CE-ML)
01/01/2021 Summary SBC
Select Plus Platinum 15/250/20% (CE-MK)
01/01/2021 Summary SBC
Select Plus Gold 30/30% (CE-M3)
01/01/2021 Summary SBC
Select Plus Gold 30/500/20% (CE-M4)
01/01/2021 Summary SBC
Select Plus Gold 35/1000/20% (CE-M5)
01/01/2021 Summary SBC
Select Plus Gold Primary Advantage 1500/30% (CE-M6)
01/01/2021 Summary SBC
Select Plus Silver 55/1750/40% (CE-M7)
01/01/2021 Summary SBC
Select Plus Silver 55/2250/40% (CE-M8)
01/01/2021 Summary SBC
Select Plus Silver HDHP w/Motion 2550/40% (CE-MM)
01/01/2021 Summary SBC
Select Plus Bronze HDHP w/Motion 7000/0% (CE-MN)
01/01/2021 Summary SBC
Select Plus Bronze 7200/40% (CE-MO)
01/01/2021 Summary SBC
Core PPO Network
Core Platinum 15/10% (CE-MP)
01/01/2021 Summary SBC
Core Platinum Primary Advantage 250/20% (CE-MR)
01/01/2021 Summary SBC
Core Platinum 15/250/20% (CE-MQ)
01/01/2021 Summary SBC
Core Gold 30/30% (CE-M9)
01/01/2021 Summary SBC
Core Gold 30/500/20% (CE-NA)
01/01/2021 Summary SBC
Core Gold 35/1000/20% (CE-NB)
01/01/2021 Summary SBC
Core Gold Primary Advantage 1500/30% (CE-NC)
01/01/2021 Summary SBC
Core Silver 55/1750/40% (CE-ND)
01/01/2021 Summary SBC
Core Silver 55/2250/40% (CE-NE)
01/01/2021 Summary SBC
Core Silver HDHP w/Motion 2550/40% (CE-MS)
01/01/2021 Summary SBC
Core Bronze HDHP w/Motion 7000/0% (CE-MT)
01/01/2021 Summary SBC
Core Bronze 7200/40% (CE-MU)
01/01/2021 Summary SBC
2021 Medical EPO Choice Simplified
Doctor's Plan EPO
Doctor's Plan Platinum 15/10% (CE-MV)
01/01/2021 Summary SBC
Doctor's Plan Platinum Primary Advantage 250/20% (CE-MX)
01/01/2021 Summary SBC
Doctor's Plan Platinum 15/250/20% (CE-MW)
01/01/2021 Summary SBC
Doctor's Plan Gold 30/30% (CE-NF)
01/01/2021 Summary SBC
Doctor's Plan Gold 30/500/20% (CE-NG)
01/01/2021 Summary SBC
Doctor's Plan Gold 35/1000/20% (CE-NH)
01/01/2021 Summary SBC
Doctor's Plan Gold Primary Advantage 1500/30% (CE-NI)
01/01/2021 Summary SBC
Doctor's Plan Silver 55/1750/40% (CE-NJ)
01/01/2021 Summary SBC
Doctor's Plan Silver 55/2250/40% (CE-NK)
01/01/2021 Summary SBC
Doctor's Plan Silver HDHP w/Motion 2550/40% (CE-MY)
01/01/2021 Summary SBC
Doctor's Plan Bronze HDHP w/Motion 7000/0% (CE-MZ)
01/01/2021 Summary SBC
Doctor's Plan Bronze 7200/40% (CE-M2)
01/01/2021 Summary SBC
2021 Medical HMO State Package
Alliance HMO Network
State Alliance Platinum 90 HMO 0/15 (CE-OK)
01/01/2021 Summary SBC
State Alliance Gold 80 HMO 350/25 (CE-OL)
01/01/2021 Summary SBC
State Alliance Silver 70 HMO 2250/50 (CE-OM)
01/01/2021 Summary SBC
2021 Medical EPO State Package
Navigate EPO Network
State Navigate Platinum 15/10% (CD-FB)
01/01/2021 Summary SBC
State Navigate Gold 25/350/20% (CD-FC)
01/01/2021 Summary SBC
State Navigate Silver 50/2250/30% (CD-FD)
01/01/2021 Summary SBC
State Navigate Bronze 65/6300/40% (CD-FE)
01/01/2021 Summary SBC
2021 Medical PPO State Package
Core PPO Network
State Core Platinum 15/10% (CE-MA)
01/01/2021 Summary SBC
State Core Platinum 15/10% (CE-MA) INF
01/01/2021 Summary SBC
State Core Gold 25/350/20% (CE-MB)
01/01/2021 Summary SBC
State Core Gold 25/350/20% (CE-MB) INF
01/01/2021 Summary SBC
State Core Silver 50/2250/30% (CE-MC)
01/01/2021 Summary SBC
State Core Silver 50/2250/30% (CE-MC) INF
01/01/2021 Summary SBC
State Core Bronze 65/6300/40% (CE-MD)
01/01/2021 Summary SBC
State Core Bronze 65/6300/40% (CE-MD) INF
01/01/2021 Summary SBC
2021 Non-Differential PPO - for employees residing outside a Select Plus or Core service area
Non-Differential PPO Silver 2250/30% (CE-MI) - Available in State Package Only
01/01/2021 Summary SBC
2020 Choice Simplified Packages- refer to the guide below to confirm allowed plan pairings
Choice Simplified Packages 1.20
01/01/2020 Summary
2020 Medical HMO Choice Simplified
Signature HMO Network
Signature Platinum Primary Advantage 0-80/20% (BR-SP)
01/01/2020 Summary SBC
Signature Platinum 20-40/20% (BR-SQ)
01/01/2020 Summary SBC
Signature Platinum 20-40/500d (BR-SO)
01/01/2020 Summary SBC
Signature Gold 30-60/20%/500ded (BR-SR)
01/01/2020 Summary SBC
Signature Gold 30-60/1000d (BH-GT)
01/01/2020 Summary SBC
Signature Gold 30-60/30%/1250ded (BR-ST)
01/01/2020 Summary SBC
Signature Gold Primary Advantage 0-80/30%/1500ded (BR-SS)
01/01/2020 Summary SBC
Signature Silver 55-80/40%/2250ded (BR-SU)
01/01/2020 Summary SBC
Advantage HMO Network
Advantage Platinum Primary Advantage 0-80/20% (BR-SW)
01/01/2020 Summary SBC
Advantage Platinum 20-40/20% (BR-SX)
01/01/2020 Summary SBC
Advantage Platinum 20-40/500d (BR-SV)
01/01/2020 Summary SBC
Advantage Gold 30-60/20%/500ded (BR-SY)
01/01/2020 Summary SBC
Advantage Gold 30-60/1000d (BH-GZ)
01/01/2020 Summary SBC
Advantage Gold Primary Advantage 0-80/30%/1500ded (BR-SZ)
01/01/2020 Summary SBC
Advantage Silver 55-80/40%/2250ded (BR-S3)
01/01/2020 Summary SBC
Alliance HMO Network
Alliance Platinum Primary Advantage 0-80/20% (BR-TN)
01/01/2020 Summary SBC
Alliance Platinum 20-40/500d (BR-TM)
01/01/2020 Summary SBC
Alliance Gold 30-60/20%/500ded (BR-TP)
01/01/2020 Summary SBC
Alliance Gold 30-60/1000d (BH-HD)
01/01/2020 Summary SBC
Alliance Gold 30-60/30%/1250ded (BR-TR)
01/01/2020 Summary SBC
Alliance Gold Primary Advantage 0-80/30%/1500ded (BR-TQ)
01/01/2020 Summary SBC
Alliance Silver 55-80/40%/2250ded (BR-TS)
01/01/2020 Summary SBC
Focus HMO Network
Focus Platinum Primary Advantage 0-80/20% (BR-S5)
01/01/2020 Summary SBC
Focus Platinum 20-40/500d (BR-S4)
01/01/2020 Summary SBC
Focus Gold 30-60/20%/500ded (BR-S7)
01/01/2020 Summary SBC
Focus Gold 30-60/1000d (BH-G7)
01/01/2020 Summary SBC
Focus Gold Primary Advantage 0-80/30%/1500ded (BR-S8)
01/01/2020 Summary SBC
Focus Silver 55-80/40%/2250ded (BR-TA)
01/01/2020 Summary SBC
Harmony HMO Network
Harmony Platinum Primary Advantage 0-80/20% (BR-TC)
01/01/2020 Summary SBC
Harmony Platinum 20-40/500d (BR-TB)
01/01/2020 Summary SBC
Harmony Gold 30-60/20%/500ded (BR-TE)
01/01/2020 Summary SBC
Harmony Gold 30-60/1000d (BK-D2)
01/01/2020 Summary SBC
Harmony Gold 30-60/30%/1250ded (BR-TG)
01/01/2020 Summary SBC
Harmony Gold Primary Advantage 0-80/30%/1500ded (BR-TF)
01/01/2020 Summary SBC
Harmony Silver 55-80/40%/2250ded (BR-TH)
01/01/2020 Summary SBC
Harmony Silver 30%/2250ded (BR-TI)
01/01/2020 Summary SBC
Harmony Bronze HDHP w/Motion 0%/6900ded (BR-TK)
01/01/2020 Summary SBC
Harmony Bronze HDHP 40%/7200ded (BR-TL)
01/01/2020 Summary SBC
2020 Medical PPO Choice Simplified
Select Plus PPO Network
Select Plus Platinum 10/10% (BR-JF)
01/01/2020 Summary SBC
Select Plus Platinum Primary Advantage 250/20% (BR-JH)
01/01/2020 Summary SBC
Select Plus Platinum 15/250/20% (BR-JG)
01/01/2020 Summary SBC
Select Plus Gold 25/30% (BR-J3)
01/01/2020 Summary SBC
Select Plus Gold 25/500/20% (BR-J4)
01/01/2020 Summary SBC
Select Plus Gold 25/1000/20% (BR-J5)
01/01/2020 Summary SBC
Select Plus Gold Primary Advantage 1500/30% (BR-J6)
01/01/2020 Summary SBC
Select Plus Silver 50/1500/40% (BR-J7)
01/01/2020 Summary SBC
Select Plus Silver 50/2250/40% (BR-J8)
01/01/2020 Summary SBC
Select Plus Silver HDHP w/Motion 2300/30% (BR-JI)
01/01/2020 Summary SBC
Select Plus Bronze HDHP w/Motion 6900/0% (BR-JJ)
01/01/2020 Summary SBC
Select Plus Bronze 7200/40% (BR-JK)
01/01/2020 Summary SBC
Core PPO Network
Core Platinum 10/10% (BR-JL)
01/01/2020 Summary SBC
Core Platinum Primary Advantage 250/20% (BR-JN)
01/01/2020 Summary SBC
Core Platinum 15/250/20% (BR-JM)
01/01/2020 Summary SBC
Core Gold 25/30% (BR-J9)
01/01/2020 Summary SBC
Core Gold 25/500/20% (BR-KA)
01/01/2020 Summary SBC
Core Gold 25/1000/20% (BR-KB)
01/01/2020 Summary SBC
Core Gold Primary Advantage 1500/30% (BR-KC)
01/01/2020 Summary SBC
Core Silver 50/1500/40% (BR-KD)
01/01/2020 Summary SBC
Core Silver 50/2250/40% (BR-KE)
01/01/2020 Summary SBC
Core Silver HDHP w/Motion 2300/30% (BR-JO)
01/01/2020 Summary SBC
Core Bronze HDHP w/Motion 6900/0% (BR-JP)
01/01/2020 Summary SBC
Core Bronze 7200/40% (BR-JQ)
01/01/2020 Summary SBC
2020 Medical HMO State Package
Advantage HMO Network
State Advantage (Non-Mirror) Gold 30-60/30%/1250ded (BR-S2)
01/01/2020 Summary SBC
Alliance HMO Network
State Alliance Platinum 15-30/10% (BR-TX)
01/01/2020 Summary SBC
State Alliance (Non-Mirror) Platinum 20-40/20% (BR-TO)
01/01/2020 Summary SBC
State Alliance Gold 25-50/20%/250ded (BR-TY)
01/01/2020 Summary SBC
State Alliance Silver 50-85/20%/2250ded (BR-TZ)
01/01/2020 Summary SBC
State Alliance (Non-Mirror) Silver 30%/2250ded (BR-TT)
01/01/2020 Summary SBC
State Alliance Bronze HDHP 0%/6900 (BR-T2)
01/01/2020 Summary SBC
State Alliance (Non-Mirror) Bronze HDHP 0%/6900ded (BR-TU)
01/01/2020 Summary SBC
State Alliance (Non-Mirror) Bronze HDHP 40%/7200ded (BR-TW)
01/01/2020 Summary SBC
Focus HMO Network
State Focus (Non-Mirror) Platinum 20-40/20% (BR-S6)
01/01/2020 Summary SBC
State Focus (Non-Mirror) Gold 30-60/30%/1250ded (BR-S9)
01/01/2020 Summary SBC
Harmony HMO Network
State Harmony (Non-Mirror) Platinum 20-40/20% (BR-TD)
01/01/2020 Summary SBC
2020 Medical EPO State Package
Navigate EPO Network
State Navigate Platinum 15/10% (BR-5Y)
01/01/2020 Summary SBC
State Navigate Gold 25/250/20% (BR-5Z)
01/01/2020 Summary SBC
State Navigate Silver 50/2250/20% (BR-52)
01/01/2020 Summary SBC
State Navigate Bronze 65/6300/40% (BR-53)
01/01/2020 Summary SBC
2020 Medical PPO State Package
Core PPO Network
State Core Platinum 15/10% (CB-TG) [new effective 7/1/2020]
07/01/2020 Summary SBC
State Core Platinum 15/10% (CB-TG) INF [new effective 7/1/2020]
07/01/2020 Summary SBC
State Core Gold 25/250/20% (CB-TH) [new effective 7/1/2020]
07/01/2020 Summary SBC
State Core Gold 25/250/20% (CB-TH) INF [new effective 7/1/2020]
07/01/2020 Summary SBC
State Core Silver 50/2250/20% (CB-TI) [new effective 7/1/2020]
07/01/2020 Summary SBC
State Core Silver 50/2250/20% (CB-TI) INF [new effective 7/1/2020]
07/01/2020 Summary SBC
State Core Bronze 65/6300/40% (CB-TJ) [new effective 7/1/2020]
07/01/2020 Summary SBC
State Core Bronze 65/6300/40% (CB-TJ) INF [new effective 7/1/2020]
07/01/2020 Summary SBC
2020 Non-Differential PPO - for employees residing outside a Select Plus or Core service area
Non-Differential PPO Silver 2250/30% (BR-SK) - Available in Choice Simplified III & IV and State Packages
01/01/2020 Summary SBC
2020 Dental Simplified 2.0 Plans
Dental HMO
Platinum D125C - Contributory
01/01/2020 Summary
Platinum D126C - Voluntary
01/01/2020 Summary
Gold D175C - Contributory
01/01/2020 Summary
Gold D176C - Voluntary
01/01/2020 Summary
Silver D250C - Contributory
01/01/2020 Summary
Silver D251C - Voluntary
01/01/2020 Summary
Dental PPO
Platinum P4887/UCR90 - Contributory
01/01/2020 Summary
Platinum P4886/UCR90 - Contributory
01/01/2020 Summary
Platinum P8998/MAC - Contributory
01/01/2020 Summary
Platinum 1P646/MAC - Voluntary
01/01/2020 Summary
Gold 1X744/UCR90 - Contributory
01/01/2020 Summary
Gold 1X752/UCR90 - Contributory
01/01/2020 Summary
Gold 1X754/MAC - Contributory
01/01/2020 Summary
Gold 1P750/MAC - Voluntary
01/01/2020 Summary
Silver P0079/UCR90 - Contributory
01/01/2020 Summary
Silver P4883/UCR90 - Contributory
01/01/2020 Summary
Silver P3437/MAC - Contributory
01/01/2020 Summary
Silver P5425/MAC - Voluntary
01/01/2020 Summary
Bronze A7976/MAC - Contributory
01/01/2020 Summary
Bronze A8012/MAC - Voluntary
01/01/2020 Summary
2020 Vision Simplified Plans
Platinum SH416 - Contributory
01/01/2020 Summary
Platinum SH417 - Voluntary
01/01/2020 Summary
Gold SH106 - Contributory
01/01/2020 Summary
Gold SH107 - Voluntary
01/01/2020 Summary
Silver S1076 - Contributory
03/01/2020 Summary
Silver S1077 - Voluntary
03/01/2020 Summary
Form Name Effective Date Download Form
General Information
Overview Flyer
01/01/2020 Download
Product Catalog 1.21
01/01/2021 Download
Underwriting Guidelines 7.21 (updated 4/30/2021)
07/01/2021 Download
Bundled Pricing Flyer (groups of 2 - 100)
01/01/2021 Download
COVID-19 At Home Testing FAQ
01/01/2022 Download
Packaged Savings Flyer (groups of 2 - 99)
03/01/2021 Download
2022 Producer Performance Guide
01/01/2022 Download
Health Management One Pass Flyer
01/01/2022 Download
Online Provider Search Instructions
02/01/2020 Download
MLR 2019 FInal Payout Report
01/01/2020 Download
Mobile App Employer Flyer
01/01/2020 Download
Mobile App Member Flyer
01/01/2020 Download
Peloton Health Management Member Flyer
07/01/2021 Download
Sanvello Behavioral Health App Member Flyer
07/01/2021 Download
Medical
Medical Product Grid 1.22
01/01/2022 Download
Detailed Benefit Grids 1.21 (updated 12.20)
01/01/2021 Download
Medical Product Grid 1.21
01/01/2021 Download
Medical Plan Code Reference Table 1.21
01/01/2021 Download
Plan Benefit Changes 1.21
01/01/2021 Download
Choice Simplified Package 1.22
01/01/2022 Download
Choice Simplified Package 7.21
07/01/2021 Download
HEAL Flyer
01/01/2020 Download
How to Find a UHC Contracted Freestanding Facility for Outpatient Services
01/01/2020 Download
How to Print and Order ID Cards
01/01/2020 Download
How to Register on myuhc.com
01/01/2020 Download
HSA Motion Program Flyer
02/01/2020 Download
New Member Checklist
01/01/2020 Download
Nurseline Flyer
01/01/2020 Download
Small Group Pharmacy Drug List (HMO & PPO)
01/01/2022 Download
Small Group Pharmacy Drug List (Navigate)
01/01/2022 Download
Preventive Care Services Brochure
01/01/2020 Download
Primary Advantage CA HMO Flyer
02/01/2020 Download
Primary Advantage CA PPO Flyer
02/01/2020 Download
Rally Health and Wellness Flyer
01/01/2020 Download
Real Appeal Employer Flyer
01/01/2020 Download
Real Appeal Member Flyer
01/01/2020 Download
Save Money by Using Freestanding Facilities
01/01/2020 Download
Select Plus PPO PCP Election Flyer
01/01/2022 Download
Simply Engaged Gym Reimbursement Flyer
01/01/2020 Download
HMO Network Comparison Tool 1.21
01/01/2021 Download
HMO Network Comparison Tool 1.22
01/01/2022 Download
HMO Medical Group Website Links
01/01/2020 Download
Advantage HMO Network Brochure
05/01/2020 Download
Alliance HMO Network Brochure
03/01/2020 Download
Focus HMO Network Brochure
02/01/2020 Download
Harmony HMO Network Brochure
02/01/2020 Download
Canopy Health Overview Flyer
02/01/2020 Download
Select Plus PPO Flyer
02/01/2020 Download
Core PPO Brochure
01/01/2020 Download
Navigate EPO Brochure
01/01/2020 Download
Navigate EPO FAQs
01/01/2020 Download
2020 Prescription Drug Formulary HMO & PPO (Small Group)
01/01/2020 Download
2020 Prescription Drug Formulary Navigate (Small Group)
01/01/2020 Download
Virtual Visits Flyer
01/01/2020 Download
Wellness Programs Flyer
01/01/2020 Download
Dental
Dental Simplified 2.0 Flyer
01/01/2020 Download
Dental Consumer MaxMultiplier Brochure
01/01/2020 Download
How to Search for a UHC Dental or Vision Provider
01/01/2020 Download
SmileDirectClub FAQ
01/01/2020 Download
SmileDirectClub Employer Flyer
01/01/2020 Download
SmileDirectClub PPO Member Flyer
01/01/2020 Download
Vision
Vision Simplified Flyer
01/01/2020 Download
Vision Provider Network Flyer
01/01/2020 Download
EyeSafe Flyer
03/01/2021 Download
How to Print Your Vision ID Card
01/01/2020 Download
Laser Vision Correction Flyer
01/01/2020 Download
Lens Formularies Flyer [effective 5/1/2021]
03/01/2021 Download
Lens Options Flyer
03/01/2021 Download
Vision Benefits at Warby Parker
01/01/2020 Download
Vision FAQs
01/01/2020 Download
Form Name Effective Date Download Form
Ancillary Rate Guides
Q4 2021
DHMO Dental Rate Card - California [effective 10/1/2021]
10/01/2021 Download
PPO Dental Rate Card - Southern California [effective 10/1/2021]
10/01/2021 Download
PPO Dental Rate Card - Northern California [effective 10/1/2021]
10/01/2021 Download
PPO Dental Rate Card - San Francisco Metro [effective 10/1/2021]
10/01/2021 Download
Small Business Vision Card - California [effective 10/1/2021]
10/01/2021 Download
Q1 2022
PPO Dental Rate Card - Southern California [effective 1/1/2022]
01/01/2022 Download
PPO Dental Rate Card - Northern California [effective 1/1/2022]
01/01/2022 Download
PPO Dental Rate Card - San Francisco Metro [effective 1/1/2022]
01/01/2022 Download
Small Business Vision Card - California [effective 1/1/2022]
01/01/2022 Download