top of page
Below you will find a list of commonly used forms for groups with United Healthcare Level Funded plans available for download. While we do the best we can to keep everything up to date, sometimes carrier websites change without our knowledge, which may mean step by step instructions may be out of date. If you notice anything doesn't work as intended, please bring it to our attention and we will correct it.
Type
Description
Form
Employee Enroll & Change Form
Can be used by any new or existing United Healthcare level funded group to enroll and make any information changes to existing members. This is also the medical underwriting application for new groups. Terminations can be made by sending an email to Shannon.Herr@hia-wi.com
Employee Waiver
When an employee declines health insurance, have them sign this form and put it in their employee file as proof that you offered coverage. This is also the waiver form used for new group enrollments.
bottom of page