CA UnitedHealthcare 400-3688 2019-2024 - Fill and Sign Printable Template Online (2024)

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CA UnitedHealthcare 400-3688 2019-2024 - Fill and Sign Printable Template Online (1)

California Small Business Employee Enrollment Form/Waiver of CoverageInstructions Complete the information requested in each section according to the guidelines provided below. Please be thorough.

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CA UnitedHealthcare 400-3688 2019-2024 - Fill and Sign Printable Template Online (2)

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Rescission FAQ

  • You can mail in a check deposit for a student or employee UCard debit account: Make out the check to UMass UCard Office. Write the account holder's campus id number in the memo field of the check. Complete a UCard Deposit Slip to go with the check.

  • A UnitedHealthcare UCard may be used to purchase approved food items, over-the-counter medications and health items and even utility bills. You UnitedHealthcare Ucard also serves as your plan ID card that you would present to a doctor or pharmacy when using your plan benefits or checking in at the gym.

  • UCard brings your benefits* together UCard makes it easier to get more out of your dual health plan. You'll use UCard when you: Buy covered healthy food and over-the-counter products. Pay utility bills.

  • Also, please be aware that you cannot withdraw funds from the UCard Debit Account. If you decide to purchase your books off-campus, the UCard Office cannot return the funds you already deposited into your UCard Debit Account. To get that money back, you would need to close your debit account completely.

  • UHC Members should call the number on the back of their ID card, and non-UHC members can call 888-638-6613. Providers should use the UHC Provider Portal Opens in a new tab or use the upgraded My Practice Profile on Link. Contractual issues should be addressed through your UHC Network contact.

  • The YU-card is York University's official photo ID and payment card that will grant you access to libraries, recreation facilities and more. Using your YU-card for purchases is fast and convenient – just load funds on your card and use it at participating locations across campus, such as the bookstore and restaurants.

  • What can you buy with your credit? Buy healthy foods like fruits and vegetables, meat, seafood, dairy products and water. Choose from thousands of OTC products, like toothpaste, first aid necessities, cough drops, bladder control pads and more. Pay utility bills like electricity, gas, water and internet.

  • ​​​​​​Medi-Cal Resources ​​​​Medi-Cal is California's Medicaid program.

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