Documents & forms

UC High Option Supplement to Medicare

2025

UC High Option Supplement to Medicare 2025 Medical Plan Benefits Summary—English [PDF]

UC High Option Supplement to Medicare 2025 Medical Plan Benefits Summary—Spanish [PDF]

UC High Option Supplement to Medicare 2025 Benefit Booklet [PDF]

UC High Option Supplement to Medicare—Navitus 2025 Evidence of Coverage [PDF]

UC High Option Supplement to Medicare—Navitus 2025 Medicare Part D Formulary [PDF]

UC High Option Supplement to Medicare—Navitus MedicareRx 2025 Summary of Benefits [PDF]

UC High Option Supplement to Medicare—Navitus MedicareRx 2025 Pharmacy Directory [PDF]

2024

UC High Option Supplement to Medicare 2024 Benefit Booklet [PDF]

UC High Option Supplement to Medicare 2024 Medical Plan Benefits Summary—English [PDF]

UC High Option Supplement to Medicare 2024 Medical Plan Benefits Summary—Spanish [PDF]

UC High Option Supplement to Medicare—Navitus 2024 Evidence of Coverage [PDF]

UC High Option Supplement to Medicare—Navitus 2024 Medicare Part D Formulary [PDF]

UC High Option Supplement to Medicare—Navitus MedicareRx 2024 Summary of Benefits [PDF]

UC High Option Supplement to Medicare—Navitus MedicareRx 2024 Pharmacy Directory [PDF]

2023

UC High Option Supplement to Medicare—Navitus 2023 Vaccine Coverage [PDF]

UC High Option Supplement to Medicare 2023 Benefit Booklet [PDF]

UC High Option Supplement to Medicare 2023 Medical Plan Benefits Summary [PDF]

UC High Option Supplement to Medicare—Navitus 2023 Annual Notice of Changes [PDF]

UC High Option Supplement to Medicare—Navitus 2023 Evidence of Coverage [PDF]

UC High Option Supplement to Medicare—Navitus 2023 Medicare Part D Formulary [PDF]

UC High Option Supplement to Medicare—Navitus MedicareRx 2023 Summary of Benefits [PDF]

UC Medicare PPO

2025

UC Medicare PPO 2025 Benefit Booklet [PDF]

UC Medicare PPO 2025 Medical Plan Benefits Summary—English [PDF]

UC Medicare PPO 2025 Medical Plan Benefits Summary—Spanish [PDF]

UC Medicare PPO—Navitus 2025 Evidence of Coverage [PDF]

UC Medicare PPO—Navitus 2025 Medicare Part D Formulary [PDF]

UC Medicare PPO—Navitus MedicareRx 2025 Summary of Benefits [PDF]

UC Medicare PPO—Navitus MedicareRx 2025 Pharmacy Directory [PDF]

2024

UC Medicare PPO 2024 Benefit Booklet [PDF]

UC Medicare PPO 2024 Medical Plan Benefits Summary—English [PDF]

UC Medicare PPO 2024 Medical Plan Benefits Summary—Spanish [PDF]

UC Medicare PPO—Navitus 2024 Evidence of Coverage [PDF]

UC Medicare PPO—Navitus 2024 Medicare Part D Formulary [PDF]

UC Medicare PPO—Navitus MedicareRx 2024 Summary of Benefits [PDF]

UC Medicare PPO—Navitus MedicareRx 2024 Pharmacy Directory [PDF]

2023

UC Medicare PPO 2023 Benefit Booklet [PDF]

UC Medicare PPO 2023 Medical Plan Benefits Summary [PDF]

UC Medicare PPO—Navitus 2023 Annual Notice of Changes [PDF]

UC Medicare PPO—Navitus 2023 Evidence of Coverage [PDF]

UC Medicare PPO—Navitus 2023 Medicare Part D Formulary [PDF]

UC Medicare PPO—Navitus 2023 Vaccine Coverage [PDF]

UC Medicare PPO—Navitus MedicareRx 2023 Summary of Benefits [PDF]

UC Medicare PPO without prescription drugs

2025

UC Medicare PPO w/o Prescription Drugs 2025 Benefit Booklet [PDF]

UC Medicare PPO w/o Prescription Drugs 2025 Medical Plan Benefits Summary—English [PDF]

UC Medicare PPO w/o Prescription Drugs 2025 Medical Plan Benefits Summary—Spanish [PDF]

2024

UC Medicare PPO w/o Prescription Drugs 2024 Benefit Booklet [PDF]

UC Medicare PPO w/o Prescription Drugs 2024 Medical Plan Benefits Summary—English [PDF]

UC Medicare PPO w/o Prescription Drugs 2024 Medical Plan Benefits Summary—Spanish [PDF]

2023

UC Medicare PPO w/o Prescription Drugs 2023 Benefit Booklet [PDF]

UC Medicare PPO w/o Prescription Drugs 2023 Medical Plan Benefits Summary [PDF]

UC Medicare PPO health plans

Forms

Authorization of Release of Personal and Health Information [PDF]

International Medical Claim Form [PDF]

Medical Claim Form [PDF]

Prescription Drug Claim Form [PDF]

Prescription Drug International Claim Form [PDF]