United Healthcare
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Employer Application Package  |
Employee Application Package for New Group |
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Add Employee to Existing Group Plan |
Common Ownership Form |
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Common Law Marriage |
COBRA/State Continuation |
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.
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Plan |
Office Visit Copay
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In-Network Deductible
|
In-Network Coinsurance Rate
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$25/$50 |
$2000 |
20% |
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$30/$60 |
$3000 |
20% |
|
Ded & Coins. |
$2000 |
20% |
|
Ded & Coins. |
$3000 |
20% |
|
$25/$50 |
$2500 |
0% |
|
$25/$50 |
$250 |
10% |
|
$25/$50 |
$500 |
20% |
|
$25/$50 |
$1000 |
20% |
|
$25/$50 |
$1500 |
20% |
|
$25/$50 |
$2500 |
20% |
|
$25/$50 |
$1000 |
30% |
|
$25/$50 |
$1500 |
30% |
|
$25/$50 |
$2000 |
30% |
|
$25/$50 |
$2500 |
30% |
|
$30/$60 |
$1000 |
30% |
|
$30/$60
|
$1500 |
30% |
|
$30/$60 |
$2000 |
30% |
|
$30/$60 |
$3000 |
30% |
|
$30/$60 |
$5000 |
30% |
|
$30/$60 |
$3000 |
0% |
|
$30/$60 |
$4000 |
0% |
|
$30/$60 |
$5000 |
0% |
|
$25/$50 |
$8000 |
20% |
|
$25/$50 |
$3000 |
20% |
|
$25/$50 |
$3000 |
20% |
|
Ded & Coins. |
$2000 |
20% |
|
Ded & Coins. |
$2850 |
20% |
|
Deductible |
$2000 |
0% |
|
Deductible |
$2850 |
0% |
|
Deductible |
$5000 |
0% |
|
$30/$60 |
$2000 |
0-30% |
|
$30/$60 |
$1000 |
0-30% |
|
$30/$60 |
$1000 |
0-20% |
|
$30/$60 |
$1500 |
0-30% |
|
Deductible |
$1500 |
0-40% |
|
Deductible |
$2000 |
0-40% |
|
$25/$40 |
$1500 |
20% |
|
$40/$60 |
$4000 |
30% |
|
$25/$40 |
$0 |
NA |
|
$40/$60 |
$0 |
NA |
|
Old Plans |
|||
Plan |
Office Visit Copay
|
In-Network Deductible
|
In-Network Coinsurance Rate
|
$25/$50 |
$250 |
10% |
|
$25/$50 |
$500 |
20% |
|
$25/$50 |
$1000 |
0% |
|
$25/$50 |
$1000 |
20% |
|
$20/$35 |
$1000 |
30% |
|
$25/$50 |
$1000 |
30% |
|
$25/$50 |
$1500 |
0% |
|
$25/$50 |
$1500 |
20% |
|
$25/$50 |
$1500 |
30% |
|
Deductible |
$2000 |
0% |
|
$25/$50 |
$2000 |
0% |
|
$25/$50 |
$2000 |
20% |
|
$25/$50 |
$2000 |
30% |
|
$25 |
$2000 |
30% |
|
$25/$50 |
$2500 |
0% |
|
$25 |
$2500 |
20% |
|
$25/$50 |
$2500 |
30% |
|
$25/$50 |
$3000 |
0% |
|
Deductible |
$3000 |
0% |
|
$30 |
$3000 |
20% |
|
$25/$50 |
$3000 |
30% |
|
$25/$50 |
$4000 |
0% |
|
$25/$50 |
$5000 |
30% |
|
$25/$50 |
$5000 |
0% |
|
$30/$60+30% |
$1000 |
0% |
|
$30/$60+30% |
$1500 |
0% |
|
$30/$60+30% |
$2000 |
0% |
|
$30/$60+40% |
$1000 |
20% |
|
$30/$60+40% |
$1500 |
20% |
|
$30/$60 |
$2000 |
20% |
|
$30/$60 |
$1000 |
20% |
|
$25/$50* |
$8000 |
20% |
|
$25/$50* |
$8000 |
20% |
|
$25/$50* |
$3000 |
20% |
|
$25/$50* |
$3000 |
20% |
|
$25/$50* |
$3000 |
20% |
|
$25/$50* |
$3000 |
20% |
|
$25/$50 |
$3000 |
20% |
|
Deductible |
$2000/$4000 |
0% |
|
Deductible |
$2850/$5700 |
0% |
|
Deductible |
$3500/$7000 |
0% |
|
Deductible |
$5000/$10,000 |
0% |
|
Deductible & Coins. |
$2000/$4000 |
20% |
|
Deductible & Coins. |
$2850/$5600 |
20% |
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| Dental Plan Grid | |||
| Vision Plans | |||
Dental Plan Descriptions
For comparison of all United
Healthcare dental plans, click
here.