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Plan Documents & Resources
Find plan documents, forms and other resources to help you get the most out of your plan.
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Your plan documents may not be up to date on this site because they are currently being delivered to you by mail. In order to update your documents online, please change your preference to "online" in the Profile & Preferences page.
Plan Materials
These documents contain helpful information about your plan coverage and details on using your benefits.
Your plan documents may not be up to date on this site because they are currently being delivered to you by mail. In order to update your documents online, please change your preference to "online" in the Profile & Preferences page.
Plan Materials
These documents contain helpful information about your plan coverage and details on using your benefits.
Your plan documents may not be up to date on this site because they are currently being delivered to you by mail. In order to update your documents online, please change your preference to "online" in the Profile & Preferences page.
Plan Materials
These documents contain helpful information about your plan coverage and details on using your benefits.
Membership Materials
Membership Materials
Annual Notice of Changes Documents
2026
For provider information see the Provider Directory section below.
Annual Notice of Changes Documents
These materials will be available through 8/30/2025.
2025
For provider information see the Provider Directory section below.
For provider information see the Provider Directory section below.
Annual Notice of Changes Documents
2026
2025
2024
Provider Directory
2026 Plan Information Now Available!
If you continue to have your Medicare coverage with UnitedHealthcare next year as indicated in your Annual Notice of Changes packet, you can now view the Provider Directory for your 2026 plan. If you decide to enroll in a different plan, the information found in this Directory could change.
2026
2025
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
Provider Directory
Provider Directory
2025
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
Provider Directory
Provider Directory
2025 Plan Information Now Available!
If you continue to have your Medicare coverage with AARP® MedicareComplete® insured through UnitedHealthcare next year as indicated in your Annual Notice of Changes packet, you can now view the Provider Directory for your 2025 plan. If you decide to enroll in a different plan, the information found in your Provider Directory could change.
2025
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
Provider Directory
2026 Plan Information Now Available!
If you continue to have your Medicare coverage with AARP® MedicareComplete® insured through UnitedHealthcare next year as indicated in your Annual Notice of Changes packet, you can now view the Provider Directory for your 2026 plan. If you decide to enroll in a different plan, the information found in your Provider Directory could change.
2026
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
-
Provider Search >
Search for a physician, facility or medical group online and print directory results based on your specific search criteria.
Note: You should enter your ZIP code and select your plan to search for providers online. If you choose to view another ZIP code or plan, the results may not apply.
Other Documents
View other documents, letters or materials about your Medicare Supplement or Hospital Indemnity Plan.
My Documents
View other documents, letters or materials about your plan.
Explanation of Benefits
Your monthly EOB shows a summary of the claims we received, what we paid and what you owe.
Explanation of Benefits
Your monthly EOB shows a summary of the claims we received, what we paid and what you owe.
Explanation of Benefits
Your monthly EOB shows a summary of the claims we received, what we paid and what you owe.
SHIP EOB
Ship EOBVIEW EOB STATEMENTSExplanation of Benefits
Your monthly EOB shows a summary of the claims we received, what we paid and what you owe.
Explanation of Benefits
Your monthly EOB shows a summary of the claims we received, what we paid and what you owe.
Explanation of Benefits (EOB)
Your monthly EOB shows a summary of the claims we received, what we paid and what you owe.
Explanation of Benefits (EOB)
Your monthly EOB shows a summary of the claims we received, what we paid and what you owe.
Forms and Resources
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkMember rights and responsibilities
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkMember rights and responsibilities
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkMember rights and responsibilities
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkMember rights and responsibilities
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
- linkAppeals and Grievances – Medicare Advantage Plans
- linkMedicare Plan Appeals & Grievances Form (Online)
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
Chronic Condition Verification Form
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
-
Potential for Contract Termination
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
Chronic Condition Verification Form
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances - Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances - Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
Chronic Condition Verification Form
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx (PDF)
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form (PDF)
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx (PDF)
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form (PDF)
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan, please contact the Retiree Health Care Connect (RHCC) at 1-866-637-7555, Monday through Friday, 8:30 a.m. - 4:30 p.m. Eastern Time.
linkRetiree Health Care Connect (RHCC)
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx (PDF)
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form (PDF)
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
Summary Plan Description
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
- linkHow to appoint a representative
- linkAppointment of Representative Form
-
Complete this Authorized Representative Form to give others access to your account. Choose someone you trust such as a spouse, family member, caregiver or friend to access or help you manage your health plan.
linkAuthorization to Share Personal Information and Power of Attorney Submission Form (Online) -
For use by members and providers. Complete this form to request a formulary exception, tiering exception, prior authorization, or reimbursement.
Medicare Prescription Drug Coverage Determination Request Form
-
Some medications require information from the prescriber before filing the prescription. The prior authorization form can be given to your prescriber to complete and return to OptumRx for processing.
linkDrug-specific Prior Authorization Request Forms -
Redetermination Request Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx (PDF)
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Prescription Mail Order Form - Preferred Mail Service Pharmacy through OptumRx (PDF)
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form (PDF)
-
Commitment to quality
- linkStep Therapy for Part B drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkCoverage determinations and appeals, drug conditions and limitations and quality assurance policies
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkDisenrollment rights and responsibilities
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkCoverage determinations and appeals, drug conditions and limitations and quality assurance policies
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
To request disenrollment from your plan, please contact the Retiree Health Care Connect (RHCC) at 1-866-637-7555, Monday through Friday, 8:30 a.m. - 4:30 p.m. Eastern Time.
linkRetiree Health Care Connect (RHCC)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkCoverage determinations and appeals, drug conditions and limitations and quality assurance policies
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
- linkDisenrollment rights and responsibilities
-
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
UHC Medicare Plus Direct Member Reimbursement Form
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
-
Allow a spouse, relative, or friend to help you with your health insurance. This will allow us to release your plan information to the person(s) listed. Please remember that only you or your legal representative can give permission for someone to have access to this information. Download the form above, or call Customer Service at 1-800-523-5800 to set up your authorization over the phone. (Note: when setting up an authorization by phone you can only specify a spouse or relative.)
Privacy Authorization form
-
This program is offered in all states (including the District of Columbia and territory of Puerto Rico) except: Alaska, Connecticut, Hawaii, Idaho, North Dakota, New York and Vermont.
Part A Deductible Hospital Waiver list
-
If you need to file a claim, follow these instructions.
How to File a Claim
-
Key information to help you get the most out of your AARP® Medicare Supplement Plan from UnitedHealthcare.
Getting Started Guide
-
How your Medicare supplement plan works with Medicare.
Using Your Plan
-
Get help understanding information about your claim, including how much Medicare and your Medicare supplement plan paid the provider for the service you received, as well as any out-of-pocket costs you may have and more.
Explanation of Benefits Guide
-
Allow a spouse, relative, or friend to help you with your health insurance. This will allow us to release your plan information to the person(s) listed. Please remember that only you or your legal representative can give permission for someone to have access to this information. Download the form above, or call Customer Service at 1-800-523-5800 to set up your authorization over the phone. (Note: when setting up an authorization by phone you can only specify a spouse or relative.)
Privacy Authorization form
-
If you need to file a claim, follow these instructions.
How to File a Claim
-
Key information to help you get the most out of your AARP® Medicare Supplement Plan from UnitedHealthcare.
Getting Started Guide
-
How your Medicare supplement plan works with Medicare.
Using Your Plan
-
Get help understanding information about your claim, including how much Medicare and your Medicare supplement plan paid the provider for the service you received, as well as any out-of-pocket costs you may have and more.
Explanation of Benefits Guide
-
Allow a spouse, relative, or friend to help you with your health insurance. This will allow us to release your plan information to the person(s) listed. Please remember that only you or your legal representative can give permission for someone to have access to this information. Download the form above, or call Customer Service at 1-800-523-5800 to set up your authorization over the phone. (Note: when setting up an authorization by phone you can only specify a spouse or relative.)
Privacy Authorization form
-
This program is offered in all states (including the District of Columbia and territory of Puerto Rico) except: Alaska, Connecticut, Hawaii, Idaho, North Dakota, New York and Vermont.
Part A Deductible Hospital Waiver list
-
You may be eligible for the Michigan Medigap Subsidy, provided by the Michigan Health Endowment Fund. Learn more at www.MichiganMedigapSubsidy.com
linkMichigan Medigap Subsidy -
If you need to file a claim, follow these instructions.
How to File a Claim
-
Key information to help you get the most out of your AARP® Medicare Supplement Plan from UnitedHealthcare.
Getting Started Guide
-
How your Medicare supplement plan works with Medicare.
Using Your Plan
-
Get help understanding information about your claim, including how much Medicare and your Medicare supplement plan paid the provider for the service you received, as well as any out-of-pocket costs you may have and more.
Explanation of Benefits Guide
-
Allow a spouse, relative, or friend to help you with your health insurance. This will allow us to release your plan information to the person(s) listed. Please remember that only you or your legal representative can give permission for someone to have access to this information. Download the form above, or call Customer Service at 1-800-523-5800 to set up your authorization over the phone. (Note: when setting up an authorization by phone you can only specify a spouse or relative.)
Privacy Authorization form
-
This program is offered in all states (including the District of Columbia and territory of Puerto Rico) except: Alaska, Connecticut, Hawaii, Idaho, North Dakota, New York and Vermont.
Part A Deductible Hospital Waiver list
-
If you need to file a claim, follow these instructions.
How to File a Claim
-
Key information to help you get the most out of your AARP® Medicare Supplement Plan from UnitedHealthcare.
Getting Started Guide
-
How your Medicare supplement plan works with Medicare.
Using Your Plan
-
Get help understanding information about your claim, including how much Medicare and your Medicare supplement plan paid the provider for the service you received, as well as any out-of-pocket costs you may have and more.
Explanation of Benefits Guide
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
-
Complete the form and submit online.
linkMedical Reimbursement Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medical Reimbursement Form (PDF)
-
Complete the form and submit online.
linkMedicare Part D Claim Form (Online) -
Complete and mail the form to the address on the back of your member ID card.
Medicare Part D Claim Form (PDF)
-
View the attached FAQ’s for further information about reimbursements.
Reimbursement Form Frequently Asked Questions
- linkAppeals and Grievances – Medicare Advantage Plans
-
Complete the form and submit online.
-
Complete the form in dark ink and mail or fax using the directions on the form.
Medicare Plan Appeals & Grievances Form
-
Commitment to quality
- linkStep Therapy for Part B Drugs
- linkMember rights and responsibilities
- linkPrescription drug coverage determinations and appeals, drug conditions and limitations and quality assurance policies
- linkPrescription Drug Transition Process
- linkMedication Therapy Management (MTM) Program
-
Declaration of Prior Prescription Drug Coverage Form
- linkSeasonal flu shot information
-
Chronic Condition Verification Form
-
To request disenrollment from your plan and switch to Original Medicare only, fill out the form and submit the request online.
linkDisenrollment Form (Online) -
To request disenrollment from your plan and switch to Original Medicare only, print and complete the form in dark ink and mail or fax using the directions on the form.
Disenrollment Form
This page contains documents in PDF format. PDF (Portable Document Format) files can be viewed with Adobe® Reader®. If you don't already have this viewer on your computer, download it free from the Adobe website.opens link in new tab