Forms & 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

• Deductible-Credit-Report-Info.doc
• Common-Ownership-Certificate.doc
• UeS_OLT_Agency_Admin_Add_Remove_Form.pdf
• Group-Level-Medicare-Change-Form.doc
• Group Information Update Form
• HIPAA Disclosure Authorization Form
• SAM Enrollment Guide

• Assured Plans - Premium Designation Brochure
• Navigate Plans - Important To Know Brochure
• Navigate Premier Brochure
• Nexus ACO FAQ Brochure
• Nexus ACO Flyer
• PowerPoint Presentation
• Premium Designation Specialites

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