Download enrollment materials, enrollment change forms, product brochures and detailed benefit summaries below. If you would like supplies mailed to you, please email enrollment@euclidmanagers.com or phone 630-238-1900.
FOR NEW ILLINOIS GROUPS IN THE 1-50 MARKET
Employer Application
Employee Enrollment Form
Installation Census
Small Business Participation Form (for groups 10+ eligible)
Tax Documentation
Benefit Selection Form
ACH Form
Authorization Form
FOR NEW ILLINOIS GROUPS IN THE 51-100 MARKET
Employer Application
Employee Enrollment Form with No Medical History
Employee Enrollment Form with Medical History
Fully Insured Member Level Census
HSA OptumHealthBank Enrollment Form
FOR EXISTING ILLINOIS GROUPS WITH NEW EMPLOYEES OR EMPLOYEE STATUS CHANGES
New Hire Employee Enrollment Form
New Hire Employee Enrollment Form
If you would like to receive carrier information for UnitedHealthcare, please visit our Broker Services page to request a kit.
REQUEST A BROKER KIT
FOR GROUPS IN THE 1-50 MARKET
2022 UHC 1-50 (New Business) Illinois Product Package IL027
2022 UHC 1-50 (Renewals Only) Illinois Product Package IL028
2023 UHC 1-50 (New Business) Illinois Product Package IL029
2023 UHC 1-50 (Renewals Only) Illinois Product Package IL030
FOR GROUPS IN THE 51-100 MARKET
2023 IL & NW Indiana - July & Beyond - 51+ ATNE; 125 and under Eligible Employees
2023 IL & NW Indiana – January to July - 51+ ATNE; 125 and under Eligible Employees
HOSPITAL/NETWORK LISTING and DESCRIPTION GUIDE
UHC Network Hospital Comparison Grid
UHC Network Description
UHC Fully Insured Plan Description Guide
If the benefit summary you are looking for is not available here, please contact your Euclid Managers Account Manager.
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