Get Unitedhealthcare Enrollment/change Application - Southern State ... - Sscc

Filling out the UnitedHealthcare Enrollment/Change Application is an essential step for users wishing to initiate or modify their health coverage. This guide provides clear and user-friendly instructions to assist you in completing the application correctly online.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by selecting the type of change you wish to make by checking the appropriate box, such as 'Enroll,' 'Address Change,' 'Cancel,' or 'Name Change.' Indicate the date of the requested change.
3. Complete the 'To Be Completed By Employer' section, ensuring that the employer representative confirms all necessary details and provides their signature along with today's date.
4. Fill out the 'Employee Information' section with your personal details, including your last name, first name, address, date of birth, social security number, and contact information.
5. In 'Family Information,' list any dependents you are enrolling, changing, or cancelling, providing their names, dates of birth, and social security numbers. Indicate the type of change for each person.
6. Select the coverage options you wish to enroll in under the 'Product Selection' section. Check the boxes next to the desired benefit options.
7. Complete the 'Other Medical Coverage Information' section, detailing any additional health insurance you or your dependents may have.
8. If applicable, use the 'Waiver of Coverage' section to decline coverage for yourself, spouse, or dependents. Provide necessary reasons for the waiver.
9. Sign and date the form in the 'Signature' section, acknowledging that the information provided is complete and accurate.
10. Finally, save your changes, then download, print, or share the completed form, as required.

Complete your enrollment or change application online today for a seamless health insurance process.