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Outpatient Prescription Drug Plan Enrollment Form (Please Print)Underwritten by UnitedHealthcare Insurance CompanyRequired Information Employer/Former Employer Name: Columbia University Employer ID
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Start by obtaining the 2020 enrollment request form from the relevant department or organization.
02
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03
Begin by entering your personal information such as your full name, address, date of birth, and contact details in the designated fields.
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Provide any additional information or documentation that may be required, such as proof of residence or identification.
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Make sure to accurately complete all sections of the form, including any checkboxes or multiple-choice questions.
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Once you have completed the form, submit it by the specified deadline through the appropriate channel, such as in person, by mail, or online.
10
Keep a copy of the completed form and any associated documents for your records.
Who needs 2020 enrollment request form?
01
Anyone who wishes to enroll in a program, service, or membership for the year 2020 and is required to do so through the completion of an enrollment request form.
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