Notices/Forms

 

Creditable Coverage Letter

2022 for 2023 Creditable Coverage Letter

COVID-19 Information

Click on the following link for the most current COVID-19 information from UHC.
https://www.uhc.com/health-and-wellness/health-topics/covid-19/faq
Visit www.myuhc.com/covid for up-to-date plan and benefit information.

 

2023 Employee and Change form – use for enrollments, terminations, and changes effective 1/1/2023 and after, including Open Enrollment submissions

 

HBP Plan Information for Employees

No Surprise Billing

The document attached below provides detailed information about the federal No Surprises Act.
Prohibition on Balance Billing

Federal Surprise Billing Notice from United Healthcare

Attached below is a proposed email response for a Housing Authority to send to any out-of-network provider when the Housing Authority learns that the out-of-network provider is still “balance billing” HBP participants for services on or after January 1, 2022.  Each Housing Authority is free to revise for tone or to otherwise personalize, but the substantive message should not be changed. 
Proposed Email for Housing Authorities to send to out-of-network providers who continue to “balance bill”

Claim Forms

Medical Out of Network

Pharmacy Reimbursement

Dental

VSP Vision

UHC Vision (Out of Network)

International

Life Insurance Information

Portability and Conversion at a glance

Conversion Application

Portability Application

The Standard’s Death Claim Packet

Instructions for completing the Death Claim Packet

Waiver of Group Health Benefits

HBP Plan and Trust Document

Privacy Notice