Skip To Main Content
Select this icon to return to the home page
UniCare Difference
Shop For Insurance
Health & Wellness
Resources
Customer Support
Overview
Forms Library
FAQs
Glossary
Contact Us
Helpful Tools
Health Care Reform
Health Care Resources
Main Content
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
-Select a State-
Enrollment
Document Name
Type
Download
Member Authorization Form
PDF
Download
Member Authorization Form (en Español)
PDF
Download
Claim
Document Name
Type
Download
Dental Claim Form
PDF
Download
Life Insurance Claim Form
PDF
Download
Short-term Disability Claim Form
PDF
Download
Vision Claim Form
PDF
Download
Member Login
Register Now
Learn more about Secure Log in
Forgot username or password ?
Take a Tour
Go
*
Required Field:
Please enter a claim number before clicking the Search button.
*
Claim Number:
Can't remember your claim number?
View Claims
You are now entering
a secure site.
Forgot
username or password
?
Not Registered?
Register Now
Your request is processing...
Your browser does not support inline frames or is currently configured not to display inline frames.Please adjust it.
