Get 2013 Individual Enrollment Form - Uhccommunityplan.com

Filling out the 2013 Individual Enrollment Form for UnitedHealthcare can be straightforward with the right guidance. This comprehensive guide will take you step-by-step through the process of completing the form online, ensuring you provide all necessary information accurately and efficiently.

Follow the steps to complete the enrollment form online effectively.

1. Click the ‘Get Form’ button to obtain the enrollment form and open it in your selected document editor.
2. Begin with the applicant information section. Clearly fill in fields such as last name, first name, birth date, and social security number in black or blue ink.
3. Provide your contact information including daytime and evening phone numbers. Ensure the permanent address is accurate, avoiding P.O. Boxes.
4. If your mailing address is different from your permanent address, complete the section for mailing address.
5. For the Medicare insurance information section, retrieve your Medicare card and fill in the required details, including your Medicare claim number.
6. Select your payment options for the plan premium. Choose among automatic deduction from Social Security, Electronic Funds Transfer (EFT), or a coupon book.
7. Indicate your preferred benefit plan by selecting one of the options provided related to Health Maintenance Organizations, Preferred Provider Organizations, or Point of Service plans.
8. Select your primary care physician from the provided directory, entering their name and ID as required.
9. Respond to the important questions regarding current health conditions and coverage to help determine your eligibility.
10. Review the statements of understanding carefully, confirming your comprehension and willingness to abide by the conditions.
11. Sign and date the form to ensure your application can be processed.
12. Once everything is complete, save changes, download the document, or print it for your records before submitting.

Complete your enrollment form online today to ensure timely processing and access to your healthcare plan.