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  • United Healthcare Enrollment Application Change Cancellation Request Form

Get United Healthcare Enrollment Application Change Cancellation Request Form

Enrollment Application/Change/Cancellation Request UnitedHealthcare Insurance Company UnitedHealthcare Insurance Company of the River Valley UnitedHealthcare Plan of the River Valley, Inc. To Be Completed.

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Short term health insurance plans can be cancelled at any time without penalty. If you need coverage for longer, you may be able to apply for another short term insurance plan.

Cancel by phone To cancel a plan or ask a question, you can cancel Marketplace coverage for all household members by calling the Marketplace Call Center at 1-800-318-2596 (TTY: 1-855-889-4325). Available 24 hours a day, 7 days a week.

Sign in to your health plan account to view and/or download and print a copy of the form. Call the number on your member ID card or other member materials. Complete the 1095B Paper Request Form (pdf) and email it to your health plan at the email address listed on the form.

How do I change my name or address? Contact your organization's Benefit Administrator to change your name or address. They will forward the information to us. Contact the toll-free number on the back of your medical ID card.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232