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RBG, TULSA - FORMS
UNITEDHEALTHCARE RELEASED DOWNLOAD
Employer Enrollment
1099 Eligibility Form
1/9/2011   Download
AR Employer Application 2-99
 1/9/2011   Download
AR Employer Health Addendum 2-99
 1/9/2011   Download
Common Ownership Form
1/9/2011   Download
Direct Debit Prime Form
1/9/2011   Download
KS Employer Application 2-99
 8/11/2011   Download
OK Employer Application 2-99
 9/29/2011   Download
OK Employer Group Questionnaire 26-50 lives
 1/6/2011   Download
OK Plan Selection Form
1/5/2011   Download
Employee Enrollment
2011 Open Enrollment Brochure
 2/2/2011   Download
AK EE enrollment 2-14 Long Form
1/9/2011   Download
AR EE Enrollment 15-50 Short Form
1/9/2011   Download
AR EE enrollment form 2-99
 1/9/2011   Download
AR EE enrollment form 51-99
 1/9/2011   Download
KS EE enrollment 2-25 Short Form
5/19/2011   Download
KS EE enrollment form 26-50 Short Form
 5/19/2011   Download
KS EE enrollment form 51-99
 5/19/2011   Download
OK EE Enrollment Form 2-50
 1/9/2013   Download
OK Universal Health Questionnaire
 1/9/2013   Download
Rights & Responsibilites Brochure

Description:
To be used during enrollment meetings (pdf , 840k)

1/9/2011   Download
Administration
2011 HSA Contribution Guidelines
 1/9/2011   Download
Basic Life Portability Form
1/9/2011   Download
Employer eService for Employers & Brokers
 4/3/2011   Download
eService Add/Remove Form
1/9/2011   Download
eService Delegation Form
1/9/2011   Download
eService Form 2-50
1/9/2011   Download
HSA Application
1/9/2011   Download
Life Conversion Form
1/9/2011   Download
LTD Portability Form
1/9/2011   Download
Optum Bank Privacy Policy
1/9/2011   Download
Select HRA Application
1/9/2011   Download
Claims
AD&D Claim Form
1/9/2011   Download
Advantage PDL List 2011
 9/7/2011   Download
Dental Claim Form
1/9/2011   Download
Health Claim Form
1/9/2011   Download
LIfe Claim Form - OK
 1/9/2011   Download
Life Claim Form KS & AR
 1/9/2011   Download
Life Waiver Claim Form
1/9/2011   Download
LTD Claim Package
1/9/2011   Download
Medco Mail Order Form
1/9/2011   Download
Michelles Law Claim Form
1/9/2011   Download
Notice of Claim - Accelerated Benefit
1/9/2011   Download
Progression RX Brochure
 3/27/2011   Download
RX - PDL Tracker 04-2011
 9/7/2011   Download
Select HRA Claim Form
1/9/2011   Download
STD Claim Package
1/9/2011   Download
Other
51-99 Broker Submission Checklist
1/9/2011   Download
AR Ancillary NB Packet 2-51
 1/9/2011   Download
AR NB Packet 2-50
1/9/2011   Download
AR NB Packet 51-99
 1/9/2011   Download
Disclosure Authorization

Description:
To be used when submitting competitor forms to FastTrack (doc , 31k)

1/9/2011   Download
KS Ancillary NB Case Submission Checklist
1/9/2011   Download
KS Required Tax Documentation for Small Group
 1/9/2011   Download
KS Small Business New Case Submission Checklist
 5/19/2011   Download
OK Ancillary NB Case Submission Checklist
 1/9/2011   Download
OK Required Tax Documentation for Small Group
 1/9/2011   Download
OK Small Business New Case Submission Checklist
 1/9/2011   Download
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