California

Benefits Documents

2025 Benefits

2025 Benefits Brochure 

2025 OE Flyer with changes 

Domestic Partner Declaration

Medical Provider Search (Pre-Member)

Merchants SmartID Theft

Quit for Life

 

 
Summary of Benefits & Coverage



2025 HMO SBC 

2025 PPO HDHP SBC

2025 PPO SBC

Supplemental Benefits

Accident - $50 Wellness

Accident Benefit Summary Bi-Weekly

Accident Benefit Summary Semi-Monthly

Beneficiary Designation for Life Insurance

Benefit Assist Flier

Critical Illness- $50 Wellness

Critical Illness Benefit Summary Bi-Weekly

Critical Illness Benefit Summary Semi-Monthly

EOI ALL States other than NJ and NY

EOI NJ

EOI NY

Hospital Indemnity Benefit Summary Bi-Weekly

Hospital Indemnity Benefit Summary Semi-Monthly

Life- Value Added Services

LTD Employer Paid Summary

Class 3- Bi-Weekly Life Benefit Summary

Class 3- Semi-Monthly Life Benefit Summary

STD Buy-up Summary Bi-Weekly

STD Employer Paid Summary

UHC STD Buy-up Summary Semi Monthly

High Deductible Health Plan Overview

How Does an HDHP Work?
Health Savings Account (HSA)

Optum HSA User Guide

2025 HSA Election Form


Flexible Savings Account (FSA)

How to File an FSA Claim

How to file an FSA on the Mobile App

Eligible & Ineligible FSA Expenses

Health FSA with Dependent Care

FAQ for Terminated FSA Participants

FSA Plan year Balance and Run Out Period

FSA Summary Plan Description iSolved

FSA Reimbursement Form 
How to Select the Medical Plan
that's Right For You


Life Stage Medical Plan Considerations

Dental & Vision Benefits

Dental ENDP Benefit Summary

Dental ENDP Welcome Guide

Dental PPO Benefit Summary

Dental ID Cards

Vision Benefit Summary

Vision ID Cards

How to look up a UHC Dental and Vision provider

Employee Assistance Program 

EAP- Member Assistance Program

Compliance

2025 Compliance Packet
Pharmacy (Rx)

Vital Medication Program List

HDHP-HSA Core Plus Preventive List

Pharmacy Essential Drug List 4 Tier

Pharmacy Home Delivery ORDER FORM

Pharmacy Home Delivery Overview

Pharmacy Search Online Essential 4 Tier

Vital Medication Program Member Flyer

UHC Program Flyers

Activate Your myuhc.com Account 

Disabled Dependent Child Certification Form 4-2023 Version - PDF Fillable

MyUHC Member Flyer

One Pass Select Fitness Program

Quit for Life

Transition of Care and Continuity of Care form

UHC Rewards Wellness Program

UHC Rewards FAQ (help on how to link device)

UHC Welcome Brochure

UnitedHealthcare App

Virtual Visits 24-7

Virtual Visit Flyer

Value Adds (Will Prep Beneficiary Services, Travel Assist)

Claims Forms

Accident, Critical Illness, and Hospital Indemnity Claim Form

UHC Life Claim Form

UHC LTD Claim Form

UHC STD Claim Form

Wellness Benefit Claim Form for Accident Insurance

Wellness Benefit Claim Form for Critical Illness Insurance

Wellness Benefit Claim Form for Hospital Indemnity

Portability & Conversion

Accident Insurance Request for Portability Form

Critical Illness Request for Portability Form

Life Portability Form

Life Portability Flyer

Life Conversion Form

Life Conversion Flyer

Individual Life Conversion Form