If you are working with a consumer that requests a non-subsidized, off-exchange plan in:
Alabama, Arizona, Colorado, Florida, Georgia, Illinois, Missouri, Ohio, or Texas, you can assist your consumer electronically through our Quote & Enroll. Once logged in, click on “Quote Off-Ex Medical” in the upper right-hand corner of the dashboard.
For information on Off-Exchange enrollment, please review our Quote and Enrollment guide in Knowledge Center > Training and Guides.
Off-Exchange Enrollments Forms
If you are working with a consumer that requests a non-subsidized, off-exchange plan in the states below, a paper enrollment application can be accessed below.
- Step 1 – Click the appropriate state link below (each state form is unique)
- Step 2 – Add agent name and NPN in the blank space on the last page of the enrollment form and provide to consumer (agent to assist consumer as needed)
- Step 3 – Consumer must sign and email completed PDF form to uhcops_be_exchanges@uhc.com or via U.S. Postal Service to the following address
UnitedHealthcare
Community Plan
P.O. Box 30753
Salt Lake City, UT 84130
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