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
01/01/2018 Download
Employer Application for Small Business
01/01/2018 Download
Employer Application for Standalone Dental & Vision
01/01/2018 Download
Product and Benefit Selection Form
01/01/2018 Download
Product and Benefit Selection Form (for 11-1-2018 and later effective dates)
11/01/2018 Download
Participation & Floor Certification Form (for groups with 10 or more employees)
01/01/2018 Download
1099 Independent Contractor Attestation
01/01/2018 Download
Common Ownership Certificate
01/01/2018 Download
In Force Group Forms
Group Acceptance/Change Form (GAF)
01/01/2018 Download
Group Acceptance/Change Form (GAF) (for 11-1-18 and later effective dates)
11/01/2018 Download
Group Information Change Form
01/01/2018 Download
Employee Open Enrollment Changes Spreadsheet
01/01/2018 Download
Employer Group Reporting Form
01/01/2018 Download
Plan Year Change Request Form
01/01/2018 Download
Scheduled Direct Debit (for ongoing premium payments after installation)
01/01/2018 Download
Administration
Employer Administration Guide Medical
01/01/2018 Download
Employer eServices Reference Guide
01/01/2018 Download
Employer eServices Login Help
01/01/2018 Download
Employer eServices Website Tips
01/01/2018 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Application
01/01/2018 Download
Employee Application - Standalone Dental & Vision
01/01/2018 Download
Employee Application - Life and DI
01/01/2018 Download
Life Beneficiary Form
01/01/2018 Download
Transition of Care Form
01/01/2018 Download
Claim Forms
Authorization for the Use and Disclosure of Information
01/01/2018 Download
Medical Claim Form
01/01/2018 Download
International Claim Form
01/01/2018 Download
Pharmacy Claim Form
01/01/2018 Download
Mail Order Pharmacy Form
01/01/2018 Download
Dental Claim Form
01/01/2018 Download
Vision Claim Form (out of network reimbursement)
01/01/2018 Download
Form Name Effective Date Download Form
2018 Medical HMO Choice Simplified Packages
Signature HMO Network
Signature Platinum 20-40/30% (AV-L7)
01/01/2018 Summary SBC
Signature Gold 30-50/30% (AV-L8)
01/01/2018 Summary SBC
Signature Gold 30-50/30%/1000ded (AV-L9)
01/01/2018 Summary SBC
Signature Silver 50-75/40%/2250ded (AV-MA)
01/01/2018 Summary SBC
Advantage HMO Network
Advantage Platinum 20-40/30% (AV-MB)
01/01/2018 Summary SBC
Advantage Gold 30-50/30% (AV-MC)
01/01/2018 Summary SBC
Advantage Gold 30-50/30%/1000ded (AV-MD)
01/01/2018 Summary SBC
Advantage Silver 50-75/40%/2250ded (AV-ME)
01/01/2018 Summary SBC
Alliance HMO Network
Alliance Platinum 20-40/30% (AV-MJ)
01/01/2018 Summary SBC
Alliance Gold 30-50/30% (AV-MK)
01/01/2018 Summary SBC
Alliance Gold 30-50/30%/1000ded (AV-ML)
01/01/2018 Summary SBC
Alliance Silver 50-75/40%/2250ded (AV-MM)
01/01/2018 Summary SBC
Focus HMO Network
Focus Platinum 20-40/30% (AV-MF)
01/01/2018 Summary SBC
Focus Gold 30-50/30% (AV-MG)
01/01/2018 Summary SBC
Focus Gold 30-50/30%/1000ded (AV-MH)
01/01/2018 Summary SBC
Focus Silver 50-75/40%/2250ded (AV-MI)
01/01/2018 Summary SBC
2018 Medical EPO Choice Simplified Packages
Navigate EPO Network
Navigate Platinum 10/10% (AU-L7)
01/01/2018 Summary SBC
Navigate Platinum 15/20% (AU-SS)
01/01/2018 Summary SBC
Navigate Gold 25/500/20% (AU-SY)
01/01/2018 Summary SBC
Navigate Gold 25/1000/20% (AU-SZ)
01/01/2018 Summary SBC
Navigate Gold 25/1500/20% (AU-S1)
01/01/2018 Summary SBC
Navigate Silver 40/1500/30% (AU-S2)
01/01/2018 Summary SBC
Navigate Silver 40/2250/40% (AU-S3)
01/01/2018 Summary SBC
Navigate HSA Silver 2000/20% (AX-FM)
01/01/2018 Summary SBC
Navigate HSA Bronze 4800/40% (AU-ST)
01/01/2018 Summary SBC
2018 Medical PPO Choice Simplified Packages
Select Plus PPO Network
Select Plus Platinum 10/10% (AU-SI)
01/01/2018 Summary SBC
Select Plus Platinum 15/20% (AU-SJ)
01/01/2018 Summary SBC
Select Plus Gold 25/500/20% (AU-S5)
01/01/2018 Summary SBC
Select Plus Gold 25/1000/20% (AU-S6)
01/01/2018 Summary SBC
Select Plus Gold 25/1500/20% (AU-S7)
01/01/2018 Summary SBC
Select Plus Silver 40/1500/30% (AU-S8)
01/01/2018 Summary SBC
Select Plus Silver 40/2250/40% (AU-S9)
01/01/2018 Summary SBC
Select Plus HSA Silver 2000/20% (AX-FK)
01/01/2018 Summary SBC
Select Plus HSA Bronze 4800/40% (AU-SK)
01/01/2018 Summary SBC
Core PPO Network
Core Platinum 10/10% (AU-SL)
01/01/2018 Summary SBC
Core Platinum 15/20% (AU-SM)
01/01/2018 Summary SBC
Core Gold 25/500/20% (AU-TB)
01/01/2018 Summary SBC
Core Gold 25/1000/20% (AU-TC)
01/01/2018 Summary SBC
Core Gold 25/1500/20% (AU-TD)
01/01/2018 Summary SBC
Core Silver 40/1500/30% (AU-TE)
01/01/2018 Summary SBC
Core Silver 40/2250/40% (AU-TF)
01/01/2018 Summary SBC
Core HSA Silver 2000/20% (AX-FL)
01/01/2018 Summary SBC
Core HSA Bronze 4800/40% (AU-SN)
01/01/2018 Summary SBC
2018 Medical HMO State Package
Signature HMO Network
State Signature Platinum 15-30/10% (AV-MN)
01/01/2018 Summary SBC
State Signature Gold 25-55/20% (AV-MO)
01/01/2018 Summary SBC
State Signature Silver 45-75/20%/2000ded (AV-MP)
01/01/2018 Summary SBC
Advantage HMO Network
State Advantage Platinum 15-30/10% (AV-MQ)
01/01/2018 Summary SBC
State Advantage Gold 25-55/20% (AV-MR)
01/01/2018 Summary SBC
State Advantage Silver 45-75/20%/2000ded (AV-MS)
01/01/2018 Summary SBC
Alliance HMO Network
State Alliance Platinum 15-30/10% (AV-MW)
01/01/2018 Summary SBC
State Alliance Gold 25-55/20% (AV-MX)
01/01/2018 Summary SBC
State Alliance Silver 45-75/20%/2000ded (AV-MY)
01/01/2018 Summary SBC
State Alliance Silver 30%/2000ded (AK-RI)
01/01/2018 Summary SBC
State Alliance Bronze 30%/6250ded (AV-MZ)
01/01/2018 Summary SBC
State Alliance HSA Bronze 40%/4800ded (AX-2G)
01/01/2018 Summary SBC
State Alliance HSA Bronze 0%/6500ded (AK-RJ)
01/01/2018 Summary SBC
Focus HMO Network
State Focus Platinum 15-30/10% (AV-MT)
01/01/2018 Summary SBC
State Focus Gold 25-55/20% (AV-MU)
01/01/2018 Summary SBC
State Focus Silver 45-75/20%/2000ded (AV-MV)
01/01/2018 Summary SBC
2018 Medical EPO State Package
Navigate EPO Network
State Navigate Platinum 15/10% (AU-SU)
01/01/2018 Summary SBC
State Navigate Gold 25/20% (AU-SV)
01/01/2018 Summary SBC
State Navigate Silver 45/2000/20% (AU-SW)
01/01/2018 Summary SBC
State Navigate Bronze 75/6300/100% (AU-SX)
01/01/2018 Summary SBC
State Navigate HSA Bronze 4800/40% (AK-SM)
01/01/2018 Summary SBC
2018 Medical PPO State Package
Select Plus PPO Network
State Select Plus Platinum 15/10% (AV-68)
01/01/2018 Summary SBC
State Select Plus Gold 25/20% (AV-69)
01/01/2018 Summary SBC
State Select Plus Silver 45/2000/20% (AV-7A)
01/01/2018 Summary SBC
State Select Plus Bronze 75/6300/100% (AV-7B)
01/01/2018 Summary SBC
State Select Plus HSA Bronze 4800/40% (AV-7C)
01/01/2018 Summary SBC
Core PPO Network
State Core Platinum 15/10% (AU-SO)
01/01/2018 Summary SBC
State Core Gold 25/20% (AU-SP)
01/01/2018 Summary SBC
State Core Silver 45/2000/20% (AU-SQ)
01/01/2018 Summary SBC
State Core Bronze 75/6300/100% (AU-SR)
01/01/2018 Summary SBC
State Core HSA Bronze 4800/40% (AK-R6)
01/01/2018 Summary SBC
Non-Differential PPO - for employees residing outside a Select Plus Service area
Non-Differential PPO Silver 2250/30% (AU-SH)
01/01/2018 Summary SBC
2017 Medical HMO Choice Simplified Packages
Signature HMO Network
Signature Platinum 20-40/30% (AK-QY)
01/01/2017 Summary SBC
Signature Gold 30-50/30% (AK-QZ)
01/01/2017 Summary SBC
Signature Gold 30-50/30%/1000ded (AK-Q1)
01/01/2017 Summary SBC
Signature Silver 45-65/40%/2000ded (AK-Q2)
01/01/2017 Summary SBC
Advantage HMO Network
Advantage Platinum 20-40/30% (AK-Q4)
01/01/2017 Summary SBC
Advantage Gold 30-50/30% (AK-Q5)
01/01/2017 Summary SBC
Advantage Gold 30-50/30%/1000ded (AK-Q6)
01/01/2017 Summary SBC
Advantage Silver 45-65/40%/2000ded (AK-Q7)
01/01/2017 Summary SBC
Alliance HMO Network
Alliance Platinum 20-40/30% (AK-RE)
01/01/2017 Summary SBC
Alliance Gold 30-50/30% (AK-RF)
01/01/2017 Summary SBC
Alliance Gold 30-50/30%/1000ded (AK-RG)
01/01/2017 Summary SBC
Alliance Silver 45-65/40%/2000ded (AK-RH)
01/01/2017 Summary SBC
Alliance Silver 30%/2000ded (AK-RI)
01/01/2017 Summary SBC
Alliance HSA Bronze 0%/6500ded (AK-RJ)
01/01/2017 Summary SBC
Focus HMO Network
Focus Platinum 20-40/30% (AK-Q9)
01/01/2017 Summary SBC
Focus Gold 30-50/30% (AK-RA)
01/01/2017 Summary SBC
Focus Gold 30-50/30%/1000ded (AK-RB)
01/01/2017 Summary SBC
Focus Silver 45-65/40%/2000ded (AK-RC)
01/01/2017 Summary SBC
2017 Medical EPO Choice Simplified Packages
Navigate Platinum 15/20% (AK-SF)
01/01/2017 Summary SBC
Navigate Gold 20/250/20% (AK-SN)
01/01/2017 Summary SBC
Navigate Gold 20/750/20% (AK-SO)
01/01/2017 Summary SBC
Navigate Gold 20/1000/20% (AK-SP)
01/01/2017 Summary SBC
Navigate Silver 30/2000/30% (AK-SQ)
01/01/2017 Summary SBC
Navigate Silver 2000/30% (AK-SG)
01/01/2017 Summary SBC
Navigate HSA Silver 2000/20% (AT-AP)
07/01/2017 Summary SBC
Navigate HSA Bronze 6500/0% (AK-SH)
01/01/2017 Summary SBC
2017 Medical PPO Choice Simplified Packages
Select Plus PPO Network
Select Plus Platinum 15/20% (AK-RV)
01/01/2017 Summary SBC
Select Plus Gold 20/250/20% (AK-R7)
01/01/2017 Summary SBC
Select Plus Gold 20/750/20% (AK-R8)
01/01/2017 Summary SBC
Select Plus Gold 20/1000/20% (AK-R9)
01/01/2017 Summary SBC
Select Plus Silver 30/2000/30% (AK-SA)
01/01/2017 Summary SBC
Select Plus Silver 2000/30% (AK-RW)
01/01/2017 Summary SBC
Select Plus HSA Silver 2000/20% (AT-AM)
07/01/2017 Summary SBC
Select Plus HSA Bronze 4800/40% (AT-AO)
07/01/2017 Summary SBC
Select Plus HSA Bronze 6500/0% (AK-RX)
01/01/2017 Summary SBC
Core PPO Network
Core Platinum 15/20% (AK-RY)
01/01/2017 Summary SBC
Core Gold 20/250/20% (AK-SB)
01/01/2017 Summary SBC
Core Gold 20/750/20% (AK-SC)
01/01/2017 Summary SBC
Core Gold 20/1000/20% (AK-SD)
01/01/2017 Summary SBC
Core Silver 30/2000/30% (AK-SE)
01/01/2017 Summary SBC
Core Silver 2000/30% (AK-RZ)
01/01/2017 Summary SBC
Core HSA Silver 2000/20% (AT-AN)
07/01/2017 Summary SBC
Core HSA Bronze 6500/0% (AK-R1)
01/01/2017 Summary SBC
2017 Medical HMO State Package
Signature HMO Network
State Signature Platinum 15-40/10% (AK-RK)
01/01/2017 Summary SBC
State Signature Gold 30-55/20% (AK-RL)
01/01/2017 Summary SBC
State Signature Silver 45-75/20%/2000ded (AK-RM)
01/01/2017 Summary SBC
Alliance HMO Network
State Alliance Platinum 15-40/10% (AK-RQ)
01/01/2017 Summary SBC
State Alliance Gold 30-55/20% (AK-RR)
01/01/2017 Summary SBC
State Alliance Silver 45-75/20%/2000ded (AK-RS)
01/01/2017 Summary SBC
State Alliance HSA Bronze 40%/4800ded (AK-RT)
01/01/2017 Summary SBC
Focus HMO Network
State Focus Platinum 15-40/10% (AK-RN)
01/01/2017 Summary SBC
State Focus Gold 30-55/20% (AK-RO)
01/01/2017 Summary SBC
State Focus Silver 45-75/20%/2000ded (AK-RP)
01/01/2017 Summary SBC
2017 Medical EPO State Package
Navigate EPO Network
State Navigate Platinum 15/10% (AK-SI)
01/01/2017 Summary SBC
State Navigate Gold 30/20% (AK-SJ)
01/01/2017 Summary SBC
State Navigate Silver 45/2000/20% (AK-SK)
01/01/2017 Summary SBC
State Navigate Bronze 75/6300/100% (AK-SL)
01/01/2017 Summary SBC
State Navigate HSA Bronze 4800/40% (AK-SM)
01/01/2017 Summary SBC
2017 Medical PPO State Package
Core PPO Network
State Core Platinum 15/10% (AK-R2)
01/01/2017 Summary SBC
State Core Gold 30/20% (AK-R3)
01/01/2017 Summary SBC
State Core Silver 45/2000/20% (AK-R4)
01/01/2017 Summary SBC
State Core Bronze 75/6300/100% (AK-R5)
01/01/2017 Summary SBC
State Core HSA Bronze 4800/40% (AK-R6)
01/01/2017 Summary SBC
Non-Differential PPO - for employees residing outside a Select Plus Service area
Non-Differential PPO Silver 2000/30% (AK-RU)
01/01/2017 Summary SBC
2018 Dental Plans
Dental Simplified - DHMO Plans
Platinum D125C - Contributory
01/01/2018 Summary
Platinum D126C - Voluntary
01/01/2018 Summary
Gold D175C - Contributory
01/01/2018 Summary
Gold D176C - Voluntary
01/01/2018 Summary
Silver D250C - Contributory
01/01/2018 Summary
Silver D251C - Voluntary
01/01/2018 Summary
Dental Simplified - DPPO Plans
Platinum X4887/UCR90 - Contributory
01/01/2018 Summary
Platinum X4884/UCR90 - Contributory
01/01/2018 Summary
Platinum X3416/UCR85 - Contributory
01/01/2018 Summary
Platinum P7089/UCR90 - Voluntary
01/01/2018 Summary
Gold P4886/UCR90 - Contributory
01/01/2018 Summary
Gold P4883/UCR90 - Contributory
01/01/2018 Summary
Gold 1X754/MAC - Contributory
01/01/2018 Summary
Gold P7088/UCR90 - Voluntary
01/01/2018 Summary
Silver P3437/MAC - Contributory
01/01/2018 Summary
Silver P7308/MAC - Contributory
01/01/2018 Summary
Silver P5425/MAC - Voluntary
01/01/2018 Summary
Bronze A7976/MAC - Contributory
01/01/2018 Summary
Bronze A8016/MAC - Contributory
01/01/2018 Summary
Bronze A8012/MAC - Voluntary
01/01/2018 Summary
2018 Vision Plans (most popular 100% employer paid and voluntary plans)
12/12/12 Plans
V1001-ER Paid
01/01/2018 Summary
L004V-Voluntary
01/01/2018 Summary
V1006-Voluntary
01/01/2018 Summary
12/12/24 Plans
V1004-ER Paid
01/01/2018 Summary
V1026--ER Paid
01/01/2018 Summary
V1076-ER Paid
01/01/2018 Summary
VH088-ER Paid
01/01/2018 Summary
VH106-ER Paid
01/01/2018 Summary
VL004-ER Paid
01/01/2018 Summary
V1007-Voluntary
01/01/2018 Summary
V1008-Voluntary
01/01/2018 Summary
V1043-Voluntary
01/01/2018 Summary
V1077-Voluntary
01/01/2018 Summary
VH008-Voluntary
01/01/2018 Summary
VH089-Voluntary
01/01/2018 Summary
VH107-Voluntary
01/01/2018 Summary
VH370-Voluntary
01/01/2018 Summary
VL008-Voluntary
01/01/2018 Summary
Form Name Effective Date Download Form
General Information
UHC Overview Flyer
01/01/2018 Download
UHC Product Catalog
01/01/2018 Download
Packaged Savings Flyer
01/01/2018 Download
UHC Provider Search Instructions
01/01/2018 Download
UHC Underwriting Guidelines (for 7-1-2018 and later effective dates)
07/01/2018 Download
UHC Underwriting Guidelines
01/01/2018 Download
Medical
UHC Medical Product Grid
01/01/2018 Download
UHC 2018 Medical Renewal Plan Mapping Grid
01/01/2018 Download
UHC Choice Simpflied Packages
01/01/2018 Download
HEAL Flyer
01/01/2018 Download
Health4Me Mobile App Flyer
01/01/2018 Download
How to Print and Order ID Cards
01/01/2018 Download
Preventive Care Services Brochure
01/01/2018 Download
Rally Health and Wellness Flyer
01/01/2018 Download
Real Appeal Employer Flyer
01/01/2018 Download
Real Appeal Member Flyer
01/01/2018 Download
Save Money by Using Freestanding Facilities
01/01/2018 Download
Simply Engaged Gym Reimbursement Flyer
01/01/2018 Download
UHC HMO Network Comparison
01/01/2018 Download
UHC HMO Medical Group Website Links
01/01/2018 Download
UHC Advantage HMO Network Brochure
01/01/2018 Download
UHC Alliance HMO Network Brochure
01/01/2018 Download
UHC Focus HMO Network Brochure
01/01/2018 Download
Canopy Health Overview Flyer
01/01/2018 Download
Canopy Health FAQ Flyer
01/01/2018 Download
UHC Core PPO Brochure
01/01/2018 Download
UHC Navigate EPO Brochure
01/01/2018 Download
UHC Select Plus PPO Flyer
01/01/2018 Download
UHC 2018 HMO Rx Formulary
01/01/2018 Download
UHC 2018 HMO Rx Formulary Update Summary
01/01/2018 Download
UHC 2018 PPO Rx Formulary
01/01/2018 Download
UHC 2018 PPO Rx Formulary Update Summary
01/01/2018 Download
Virtual Visits Flyer
01/01/2018 Download
Wellness Programs Flyer
01/01/2018 Download
Dental
Dental Simplified Flyer
04/01/2018 Download
Dental Consumer MaxMultiplier Brochure
01/01/2018 Download
How to Search for a UHC Dental or Vision Provider
01/01/2018 Download
Vision
Vision Simplified Flyer
07/01/2018 Download
Vision Provider Search Flyer
01/01/2018 Download
How to Print Your Vision ID Card
01/01/2018 Download
UHC Lens Options Brochure
01/01/2018 Download
Vision Benefits at Warby Parker
01/01/2018 Download
Form Name Effective Date Download Form
CA SB Employer Contact Sheet