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Forms for UCHealth plan members.

Continuity of Care Form Fillable
Continuity of Care Form Print
Medical Claim Form and Instructions
Flu Shot Clinic Form
UCHealth Mail Order Form for New Prescriptions
Member Authorization Form
International Claim Form
BlueView Vision Out-of-Network Claim Form
Legal Disclosure

Not connected with or endorsed by the U.S. Government or the federal Medicare program.


The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent or insurance company.


This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, please contact your agent or the health plan.



Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711). 

 

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711).

 

 注意:如 果您使用非英語的其他語言,您可以免費獲得語言援助服務。請致電聯絡客戶服務部(聽語 障用戶請致電:711)。



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