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ENROLL or WAIVE Coverage

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Gender

CHOOSE PLAN(s)

UHC Medical Plan Options:
Medical Coverage Level

** Hourly employees may only elect UHC Base 6750 or EBA MEC Plan.

UHC Dental Plan Options
Dental - Add Dependent Coverage
UHC Vision
Vision - Add Dependent Coverage

Add Dependent Information

UHC Life/AD&D Insurance Beneficiary Information

Employer paid flat $15,000 Life/AD&D benefit. 

TOTAL = 100%

Voluntary Life Insurance $50,000 - $500,000 of Life/AD&D Benefit

If you wish to cover additional dependents or add more beneficiaries, please contact Amanda Garcia at (210) 283-5571.

Organization you work for:
What type of employee are you?
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