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Sales Support

Sales Support

Agents, Brokers, and Consultants are a vital part of our business, and UnitedHealthcare values these relationships. You'll find a number of useful forms and information within this website to help you support your needs. For more information on offering UnitedHealthcare to your clients, please contact a UnitedHealthcare account representative.




Broker Enrollment Packets

GA New Business Packet 2 - 50
GA New Business Packet 51 - 99
NC Underwriting and Install Checklist
SC Underwriting and Install Checklist



Member and Employer Enrollment Applications

Click on a state to reveal downloadable enrollment applications.


Small Group - Arkansas
Applications for effective dates beginning 1/1/16
Employer Application (Groups 1-50, #262-6491)
Employee Enrollment Form (Groups 1-50, #262-6492)

Large Group - Arkansas
Applications for effective dates beginning 1/1/16
Employer Application (Groups 51+, #262-6493)
Employee Enrollment Form (Groups 51+, #262-6494)
Employee (New Hire) Enrollment Form with Medical Question (Groups 51-100, #262-6495)


Large Group - Georgia
Applications for effective dates beginning 1/1/16
Employer Application (Groups 51+, #200-8287)
Employee Enrollment Form (Groups 51+, #200-8288)
Employee Enrollment Form with Medical Question (Groups 51-100, #200-8289)

Small Group - Georgia

Applications for effective dates beginning 1/1/16
Employer Application (Groups 1-50, #200-8285)
Employee Enrollment Form (Groups 1-50, #200-8286)



Large Group - Illinois
Employer Application for groups 51+ (230-11121)
Employee Enrollment Form for groups 51-100 (230-11123)
Employee Enrollment Form for groups 51+ (230-11122)

Small Group - Illinois
Employer Application for groups 1-50 (230-11119)
Employee Enrollment Form for groups 1-50 (230-11120)


Iowa - Small Group
For effective dates beginning 1/1/16:
Employer Application (Groups 1-50, #250-6988)
Small Group Member Universal Enrollment Application (Groups 1-50)

Iowa - Large Group
For effective dates beginning 1/1/16:
Employer Application (Groups 51+, #250-6990)
Employee Enrollment Form (Groups 51+, #250-6991)
Employee Enrollment Form with Medical Question (Groups 51-100, #250-6992)


Large Group - North Carolina

Applications for effective dates beginning 1/1/16:
Employer Application (Groups 51+, #430-8186)
Employee Enrollment Form (Groups 51+, #430-8187)
Employee Enrollment Form with Medical Question (Groups 51-100, #430-8188)

Small Group - North Carolina
Underwriting and Submission Checklist 2-99
Benefit Options Checklist
Request for Proposal Form (Groups 51-99)


Applications for effective dates beginning 1/1/16:
Employer Application for SG (Groups 1-50, #430-8184)
Employee Enrollment Form for SG (Groups 1-50, #430-8185)
Small Group - Ohio
Employer Application (Groups 1-50, #290-7611)
Employee Enrollment Form (Groups 1-50, #290-7612)

Large Group - Ohio
Employer Application (Groups 51+, #290-7613)
Employee Enrollment Form (Groups 51+, #290-7614)
Employee Enrollment 1-Question Form (Groups 51+, #290-7615)


Small Group - South Carolina
Benefit Options Checklist
Underwriting and Submission Checklist 2-99
Request for Proposal Form (Groups 51-99)


Applications for effective dates beginning 1/1/16:
Employer Application (Groups 1-50, #500-6228)
Employee Enrollment Form (Groups 1-50, #500-6229)

Large Group - South Carolina

Applications for effective dates beginning 1/1/16:
Employer Application (Groups 51+, #500-6230)
Employee Enrollment Form for LG (Groups 51+, #500-6231)
Employee Enrollment Form with Medical Question (Groups 51-100, #500-6232)


Small Group - Tennessee
For effective dates beginning 1/1/16:
Employer Application for SG (Groups 1-50, #261-6693)
Employee Enrollment Form for SG (Groups 1-50, #261-6694)

Large Group - Tennessee
For effective dates beginning 1/1/16:
Employer Application for LG (Groups 51+, #261-6695)
Employee Enrollment Form for LG (Groups 51+, #261-6696)




Other Support

National Medical Support Notice (QMCSO) 
Common Ownership 
Domestic Partnership Affidavit (Large Group Only, Variation Required)
Domestic Partnership Affidavit - Georgia only
Product Grids - now available on unitedeservices.com (UES) 
HIPAA Authorization Form
Iowa Common Law Affidavit 
UnitedHealthcare Large Group Request for Proposal Checklist


Collateral & Sales Materials

Contact your account representative to order printed materials.
New Member Welcome Guide 
Care24®
Employer Administrative Guide
Member's Guide to www.uhcrivervalley.com 
Employer's Guide to www.uhcrivervalley.com 
Heritage Choice
Heritage Premier
Heritage Plus
Heritage Select Advantage
Heritage Select Primary Care Plan
Heritage Select Split Copayment
United Behavioral Health





Find a Physician or Facility


Find a Physician

Search our online directory to Find a Physician or Facility. For a paper provider directory or assistance finding a provider, please call the Customer Care number on the back of your health plan ID card.


 
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