Forms and Brochures

• Medical Claim Form
• Rx Claim Form
• Vision Out of Network Claim Form

• HSA SETUP GUIDE 2-99
• Open your Optum HSA Account
• Optum Bank HSA Application

• Group Information Update Form
• HIPAA Disclosure Authorization Form
• SAM Enrollment Guide

• Chicago & NW IN UHC Networks Flier
• Chicago Core Flier
• NexusACO FAQ
• NexusACO Overview Flier
• NexusACO Tier 1 Member Flier

• COBRA Client Termination Request
• UBES COBRA Administration Guide
• UBES COBRA Change Form
• UBES COBRA Implementation Guide
• UBES COBRA Participant Guide
• UBES COBRA Renewal Guide