Self-Service Forms

Quoting
Quote Request Form
Log in to UQuote to access Excel version of Quote Request form

Small group product forms
Small Group Enrollment Kit
Small Employer Uniform Application
Small Employer Verification Form
Small Employer Insurer Form
Employer Group Application
Employee Application for New Hires
New Group Checklist - Small Group
Certificate of Health Information Form
Parental Affidavit Form '
State Group Continuation Notice

Large group product forms
Employee Application Form
Waiver of Coverage Form
Employer Group Application
Employee Application for New Hires
New Group Checklist - Large Group
COBRA Group Continuation Notice

Personal Options product forms
Personal Options Application
Health Questionnaire
Personal Options Notice to Applicant
Authorization for Enrollment or Eligibility
Parental Affidavit Form
Declaration of Employer Status Form

Condition-specific questionnaires
Alcohol, Chemical and Drug Dependency
Allergies and Asthma
Back Disorder Problems
Behavioral Health
Blood Pressure
Cancer/Tumors
Diabetes
Headaches/Migraines
Heart Disease
Infertility
Thyroid

Change forms
Existing Group Change Form

HIPAA forms
General Authorization Form for PHI
Summary Health Information Request Form

Group reporting forms
Authorization To Release Group Health Information
Designation Of Representatives

Spanish forms
Employee Application Form
Employee Application for New Hires
Health Questionnaire
Waiver of Coverage Form
Personal Options Application

Spanish Materials
Comparison of Health Care Systems Brochure
Notice Of Privacy Practices
Spanish-speaking UW Health PCPs
Spanish-speaking UW Health Specialists