Get the free Forms - Broker - UnitedHealthcare

(DO NOT STAPLE)Employer Application for Small Business Groups with 299 Eligible Employees UnitedHealthcare of the mid-Atlantic, Inc. (The Company) 800 King Farm Boulevard, Rockville, MD 20850Optimum

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5. Provide accurate and honest information in the required fields. Double-check for any errors before proceeding.
6. If there are any specific questions or sections that you are unsure about, seek clarification or assistance from a broker or the relevant authority.
7. Make sure to sign and date the form, if required.
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