If you can’t find the form or document you’re looking for below, sign in to your member site to find more.
To request COVID-19 reimbursement, please select one of the COVID-19 Testing/Vaccine Administration reimbursement types. This form can also be used for foreign care, DME, physical therapy and other qualified services or purchases. Note: This form is for individuals that currently have, or previously had, a UnitedHealthcare insurance plan and sign in using myuhc.com. This form cannot be used by UnitedHealthcare Community Plan members, Medicare & Retirement members, UnitedHealthcare West, Expat, or some other members with insurance through their employer or an individual plan.
Note: This form cannot be used by UnitedHealthcare Medicare Advantage members (including UnitedHealthcare Dual Complete plan members)
*Oxford members, please look to the Oxford health plan forms (drawer below) to obtain your Sweat Equity Reimbursement Form.
You have the right to file a formal grievance about any of your medical care or services. You may submit a grievance for a denial of a service or denied claims within 180 calendar days of your receipt of an initial determination through our Appeals and Grievances Department. UnitedHealthcare will acknowledge receipt within 5 calendar days and provide an answer within 30 calendar days for a standard review. If your problem is urgent, UnitedHealthcare must give you a decision within 3 calendar days. Your problem is urgent if there is a serious threat to your health that must be resolved quickly. You may file a grievance by mail, fax or by submitting a GRIEVANCE FORM online. If you have any questions, or prefer to file this grievance orally, please feel free to call UnitedHealthcare Customer Service or the number on the back of your ID card.
Note: Complete and submit this form for appeals or grievances for medical or pharmacy services you received. This excludes Community Plan members, Medicare & Retirement members, UHC West, Surest and some members with insurance through their employer or individual plan. Before you start, make sure you have all applicable documents from your provider. Providing supporting documents will help with the appeal review.
There are 3 types of health insurance information forms you may need to file your taxes.
Form 1095-A is the Health Insurance Marketplace Statement. You'll receive this form if you enrolled in coverage through the Marketplace.
Form 1095-B is a form you may need when you file your taxes, depending on the law in your state.
Most fully insured UnitedHealthcare members will not automatically receive a paper copy of Form 1095-B due to a change in the tax law. However, Form 1095-B will continue to be available on member websites or by request.
Here are the ways to get a copy of your Form 1095-B:
Call UnitedHealthcare using the number on your member ID card or other member materials if you have questions about this form.
Form 1095-C is a form you may receive from your employer if get your health plan through work.
Learn more about these health care information forms for individuals from the Internal Revenue Service.
Use this form to request Certificate of Coverage (COC) document(s) when coverage is still active or to request Proof of Lost Coverage (POLC) document(s) when coverage is no longer active. This form is for individuals that currently have or previously had insurance through their employer or an individual plan through UnitedHealthcare and sign in using myuhc.com. This form should not be used by UnitedHealthcare West, Oxford, Expat, Empire or some members with insurance through their employer or an individual plan.