Benefits Open Enrollment

Annual Enrollment Information:

Health Insurance

General Informational Materials Regarding Health Insurance:

Need to add new coverage? Complete the following forms and return to UHA Human Resources:

Deduction Authorization

Enrollment Form

Health Attestation Spousal Coverage Form (For Self-employed or unemployed spouses)

Secondary Spousal Coverage Form (keep spouse on Health Insurance as a secondary coverage)

Need to drop ALL Health coverage? Complete the following form and return to UHA Human Resources:

Termination Request Form

Spousal Termination Request Form (Spouse has insurance outside UHA and will be discontinuing UHA coverage)

Need to add more dependents or drop some dependents from your coverage? Print and complete the following forms as if you were enrolling for the first time listing only those you wish to cover on your insurance.

Deduction Authorization

Enrollment Form

Health Attestation Spousal Coverage Form(For Self-employed or unemployed spouses)

Secondary Spousal Coverage Form(keep spouse on Health Insurance as a secondary coverage)