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(pdf 795.47KB)
(Last Updated:
05/04/2020)
Forms for transfers and deductions.
(pdf 530.21KB)
(Last Updated:
05/04/2020)
(pdf 373.40KB)
(Last Updated:
05/04/2020)
Forms to ask us to pay you back.
(pdf 299.45KB)
(Last Updated:
05/04/2020)
(pdf 782.78KB)
(Last Updated:
05/04/2020)
Authorization and Appointment Forms.
(pdf 99.24KB)
(Last Updated:
05/04/2020)
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(Last Updated:
05/04/2020)
(pdf 47.13KB)
(Last Updated:
05/04/2020)
(pdf 72.76KB)
(Last Updated:
05/04/2020)
Medication and Part D Coverage and Authorization Forms.
(pdf 387.04KB)
(Last Updated:
05/04/2020)
(pdf 254.83KB)
(Last Updated:
05/04/2020)
(pdf 51.06KB)
(Last Updated:
05/07/2020)
Additional resources for you to download.
(pdf 118.53KB)
(Last Updated:
05/06/2020)
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(Last Updated:
05/04/2020)
(pdf 905.63KB)
(Last Updated:
05/04/2020)
(pdf 118.53KB)
(Last Updated:
05/06/2020)
Complete this letter when a member is terminating their Medicare supplement plan (Medigap) and replacing it with a UnitedHealthcare Medicare Advantage plan.
Recursos en Espanol.
To get a UnitedHealthcare Dual Special Needs plan enrollment form (PDF), go to UHCCP.com and enter your ZIP code and click the "Find Plans" button. When you find the plan you may want to enroll in, click the "View Plan Details" button to access your enrollment form.
UnitedHealthcare health plans are offered by United Healthcare Insurance Company. We (and other private insurance companies) work with federal and state agencies to provide government-sponsored health insurance. We are not part of Medicare. We work with the Centers for Medicare & Medicaid Services (CMS) and many state governments to provide health coverage for Medicare and Medicaid recipients.
(pdf 95.31KB)
(Last Updated:
05/04/2020)
Print the PDF form. Fill it out in black/blue ink. Mail or Fax it using the directions on the form.
(pdf 83.94KB)
(Last Updated:
05/06/2020)
Print the PDF form. Fill it out in black/blue ink. Mail or Fax it using the directions on the form.
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