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United Healthcare
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Click on the button below to obtain the appropriate forms. These are pdf files to be printed, completed, and faxed to our office.
| Employee Application Package for New Group | Add Employee to Existing Group Plan | COBRA/State Continuation |
Other Forms:
Employee forms can be faxed to our office at (303) 721-1085. Please confirm that application was received by calling (303) 721-1145. Please call with any questions regarding eligibility or waiting periods.
| Health Plan Name |
Office Visit Copay |
In-Network Deductible |
In-Network Coinsurance Rate |
| $20 |
$250 | 90/10 | |
| USB | $20 | $250 | 80/20 |
| USC | $20 | $500 | 90/10 |
| USD | $20 | $500 | 80/20 |
| USE | $20 | $1000 | 90/10 |
| USF | $20 | $1000 | 80/20 |
| USG | Deductible/Coinsurance | $1500 | 90/10 |
| USH | $25 |
$1500 | 90/10 |
| Deductible/Coinsurance | $1500 | 80/20 | |
| USJ | $25 | $1500 | 80/20 |
| USK | Deductible/Coinsurance | $2000 | 90/10 |
| USL | $25 | $2000 | 90/10 |
| USM | Deductible/Coinsurance | $2000 | 80/20 |
| USN | $25 | $2000 | 80/20 |
| USO | Deductible/Coinsurance | $2500 | 90/10 |
| USP | $25 | $2500 | 90/10 |
| USQ | Deductible/Coinsurance | $2500 | 80/20 |
| USR | $25 | $2500 | 80/20 |
| USS | Deductible/Coinsurance | $3000 | 90/10 |
| UST | $30 | $3000 | 90/10 |
| USU | Deductible/Coinsurance | $3000 | 80/20 |
| USV | $30 | $3000 | 80/20 |
| USW | Deductible/Coinsurance | $5000 | 90/10 |
| USX | $30 | $5000 | 90/10 |
| USY | Deductible/Coinsurance | $5000 | 80/20 |
| USZ | $30 | $5000 | 80/20 |
| ANA | $20 | $1000 | 100/0 |
| ANB | Deductible | $1000 | 100/0 |
| ANC | $25 | $2000 | 100/0 |
| AND | Deductible | $2000 | 100/0 |
| LCA | $40 | $3000 | 100/0 |
| $30 | $3000 | 70/30 | |
| COT | $20 | $1000 | 80/20 |
| COW | $30 | $0 | No coinsurance |
| COX | $20 | $0 | No coinsurance |
| HDB | Deductible |
$1100/$2200 | 100/0 |
| HDC | Deductible | $1100/$2200 | 80/20 |
| HDD | Deductible | $2000/$4000 | 100/0 |
| HDE | Deductible | $2000/$4000 | 80/20 |
| HDF | Deductible | $2850/$5600 | 100/0 |
| HDG | Deductible | $2850/$5600 | 80/20 |
| HDH | Deductible | $2850/$5600* | 80/20* |
| HDI | Deductible | $3500/$7000 | 100/0 |
| HDJ | Deductible | $3500/$7000 | 80/20 |
| HDK | Deductible | $3500/$7000* | 80/20* |
| HDL | Deductible | $5000/$10,000 | 100/0 |
| HDM | Deductible | $5000/$10,000* | 100/0* |
* These plans do not cover preventative care.
For comparison of all United Healthcare dental plans, click here.
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Click
below for: Roper Individual Health Insurance Services |
 South Metro Denver Chamber of Commerce |
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