Medical and Hospital Group Subscriber AgreementMedical and Hospital Group Subscriber Agreement • February 2nd, 2023
This Medical and Hospital Group Subscriber Agreement (the Agreement) is entered into by UnitedHealthcare Benefits Plan of California (UnitedHealthcare), a California corporation, and the "Group," as described in Exhibit 1.
Medical and Hospital Group Subscriber AgreementMedical and Hospital Group Subscriber Agreement • December 10th, 2003 • California
Important: Please complete all sections This form cannot be processed if information is incomplete. Company Name Group Number/Plan Code Source of Enrollment# Open Enrollment # Transfer# New Hire # Rehire Date of Hire Effective Date Employer Verification Annual Salary Occupation and Title Group Life/AD&D Amount
