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CALIFORNIAUnitedHealthcare of California
Combined Evidence of Coverage and Disclosure Form (HMO)
January 1, 2016CA HMO LG 1116 (2/14)CA HMO LG 1116 (2/14)Welcome to UnitedHealthcare of CaliforniaSince
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The CA HMO LG 1-1-16 form is needed by individuals who are applying for or making changes to their health insurance coverage in the state of California. This form is specifically designed for Health Maintenance Organization (HMO) plans and may be required by the insurance provider as part of the enrollment process.
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