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Self-Service Forms

Quoting
Log in to U-Quote
Quote Request Form
Quote Request Form for Packages

Small group product forms
ACH Authorization Agreement
Certificate of Health Information Form
COBRA Group Continuation Notice 
Employer Group Application
Employee Application For New Hires 
New Group Checklist - Small Group
Parental Affidavit Form
Small Employer Insurer Form
Small Employer Uniform Application
Small Employer Verification Form
State Group Continuation Notice
Small Group Enrollment Kit
Small Employer Uniform Employee Waiver  

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

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

Medicare Select forms
Enrollment Application
Medicare Notice
Medicare Select 2009 Outline of Coverage
Medicare Select 2009 Provider Directory
Wisconsin Guide to Health Insurance for People with Medicare

Change forms
Existing Group Change 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

HIPPA 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
Employee Application For New Hires (Spanish)
Health Questionnaire
Personal Options Application
Waiver of Coverage Form

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