Claim Forms

When your client needs to file a claim, start
here to find the right form for faster processing.  

How to file a claim
Accident
Your client should complete the correct form below and submit via mail or fax. Part 1 & 2 on the claim form are required to be submitted along with all supporting documents and itemized bills. Part 3 on the claim form must be completed in full if your client has medical insurance in addition to this policy. 
 
Critical Illness 
Your client should complete the correct form below and submit via mail or fax with the required supporting documents and signed medical authorizations.
 
Dental
Your client should have the provider submit the claim on their behalf.
 
Fixed Indemnity (Health ProtectorGuard Plans)
Your client should complete the correct form below and submit via mail or fax with the required supporting documentation and itemized bills.
 
Short Term
Your client should have the provider submit the claim on their behalf.
 
Supplemental Indemnity (Hospital SafeGuard Plans)
Your client should complete the correct form below and submit via mail or fax with the required supporting documentation and itemized bills.
 
Term Life
Your client should complete the correct form below and submit via mail or fax. Include a certified copy of the Death Certificate, a copy of the obituary and copy of the police report, if applicable.
NOTE: A certified copy of the Death Certificate must be mailed. Fax copies will not be accepted.
 
Vision
We do not require a claim form. If your client would like to use a claim form, these may be accessed by visiting our vision website at www.myuhcvision.com or call us at 800-638-3120. 

Download a Claim Form

To submit the claim, please see form for fax number and mailing address.

Most products and services are underwritten by Golden Rule Insurance Company or Oxford Health Insurance, Inc.
References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies.
Administrative services are provided by United Healthcare Services, Inc.
UnitedHealthOne is a brand name that represents a portfolio of insurance options for individuals and families.
All products require separate applications. Separate policies or certificates are issued. Medical plans are medically underwritten– see the product brochures and applications.
Product availability varies by state.
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