United eServices

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FORMS - BROKER
Type	Title
	Benefit Options Checklist for CT Groups Up to 50
	Customer Request for Alternate Renewal Quotes
	Delegation Management Reference Manual for Agency Administrators
	Delegation Management Reference Manual for Delegates
	Delegation Management Reference Manual for UnitedHealthcare Representatives
	Direct Deposit Authorization Form and Instructions
	Disability Small Business Application Form
	Life Participation Form for Groups Up to 50
	Multi-Site One Source Express Request for Proposal for Groups Up to 50
	Request for Appointment Form for Groups Up To 50
	Substitute W-9 Form for Groups Up To 50
	Underwriting Quick Reference Guide for CT Groups Up to 50
	United eServices - Instructions For Requesting Delegate Access
	United eServices Agency Administrator Add/Removal Form
	United eServices Quoting Delegate Access Request Form

FORMS - EMPLOYER
Type	Title
	1099 Independent Contractors Form
	Benefit Options Checklist for CT Groups Up to 50
	Common Ownership Form for Groups Up to 50
	Disability Small Business Application Form
	Dual Option Renewal Employee Selection Form for Groups Up to 50
	Employer Application for CT Groups Up to 50
	Employer Application for CT, MA, and RI Groups Over 50
	Life Participation Form for Groups Up to 50
	Scheduled Direct Debit Authorization Form for Groups Up to 50

FORMS - EMPLOYEE
Type	Title
	Dental Claim Form
	Employee Enrollment Form for Additional Dependents for Groups Up to 50
	Employee Enrollment Form for CT Groups Up to 50
	Enrollment Form for CT, MA, and RI Groups Over 50
	HIPAA Disclosure Authorization Form
	Health Insurance Claim Form
	Prescription Drug Reimbursement Form
	Privacy Policy and Practices