Reinventing Health Care Choices.
Below is the United HealthCare data form.
In addition to the data form, you must provide the following when returning the form:
· A copy of valid licensing for each market in which you intend to sell
· A copy of Errors & Omissions policy/coverage
**Please note that NO electronic signature on the data form will be accepted for UHC. **
Once the data form has been processed by UHC, you will receive an email from UHC with the online contracting, certification instructions and a party ID to register. Online contracting instructions are provided below. You will not be issued a writing number until every step has been completed.
Please return the completed data form to Crystal Bruce at North American Life Plans for processing via fax (469-362-1314) or email (firstname.lastname@example.org).
If you are appointed with UHC and would like to move your contract under NALP, you must provide a copy of your release letter with the data form. If you haven’t written any business in the last 6 months, you are eligible to transfer but you still must complete the data form.