Get Product And Benefit Selection Form Unitedhealthcare Multi-choice

This guide provides a step-by-step approach to completing the Product And Benefit Selection Form for UnitedHealthcare Multi-Choice. By following these instructions, users can efficiently fill out the form online and ensure all necessary information is provided accurately.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to access and open the Product And Benefit Selection Form in your editing interface.
2. Begin by entering the group name and the agent name in the designated fields at the top of the form.
3. Select the billing type by checking one of the following options: Paper billing, Online only/Ebill, or Electronic Funds Transfer.
4. Choose the deductible type by marking either Calendar Year or Policy Year.
5. Indicate the specific UnitedHealthcare Multi-Choice plans being offered to employees by checking the appropriate boxes next to the plan codes listed.
6. If you are selecting an HSA plan, please specify the bank that will be used by checking either Optum Bank or Other.
7. For the dental plan section, enter the relevant plan codes or select Not elected if applicable.
8. In the vision plan section, either select the Integrated Vision plan or the Vision Buy-Up Plan, as applicable.
9. Fill in the basic life amounts for employees and dependents, specifying either Flat Amounts, multiple of salary, or selecting Not elected.
10. Complete any supplemental coverage details for Life/AD&D and STD/LTD, providing plan codes and amounts as needed.
11. Review other notes and understand the requirements stated regarding group eligibility and honesty in the form.
12. Ensure that the employer signature, date signed, and effective date are filled out at the end of the form.
13. Save changes, download the completed form, print it for records, or share it as required.

Complete your documents online today to streamline your process.