Paper Craft

ENROLL or WAIVE Coverage

Enter Enrollment Information on our Secure Site
*Required fields

Gender

CHOOSE PLAN(s)

Medical Plan Options

(choose only one)

Your Medical Plan Coverage Level
UHC Dental Plan Options
Dental - Coverage Level
UHC Vision
Vision - Coverage Level

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?
Thanks for enrolling!