Broker Broadcast
UHc/PacifiCare 2-50 Medical Review Process
To get a Medical Review on a 2-50 group with UnitedHealthcare/PacifiCare, the following information is needed:
- Completed Fast Track Form
- UHc/PacifiCare Enrollment forms – completed in full (signature
& date are required as well as height & weight of all applying, including
children) or
an approved questionnaire (signed & dated) or other carrier’s completed & signed enrollment forms.
- If using any forms other than UHC/PacifiCare forms: A signed Employer
or
Employee Release Form(s).
- Another option is to eliminate the enrollment forms by submitting the group’s current carrier HB2015 reports (premium vs. claims & monthly membership AND Large Claims Report) and enrolling census. If there are
new hires, medical applications may be required on those not covered on current carrier as of the last month of reporting.
The underwriting decision received will be firm, unless there is additional medical information revealed on the final medical application not revealed in the initial review. If the group decides to move forward with UnitedHealthcare/PacifiCare, normal enrollment materials would be required. The employees would be required to answer the medical questions on the UnitedHealthcare/PacifiCare application.
Fast Track Form
UHc ER Authorization Form
UHc EE Authorization Form
Prescreen Form
UHc/PAC 2-50 EE Enrollment Form
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