UHC NC MAPD Enrollment Kit

2026 Enrollment Request Form ¨ UHC Nursing Home Plan NC-F001 (PPO I-SNP) H0710-034-000

2026 Enrollment Request Form ¨ UHC Dual Complete NC-V001 (HMO-POS D-SNP) H5253-116-000

2026 Enrollment Request Form ¨ UHC Dual Complete NC-S3 (HMO-POS D-SNP) H5253-184-000

2026 Enrollment Request Form ¨ UHC Dual Complete NC-S2 (PPO D-SNP) H1889-034-000

2026 Enrollment Request Form ¨ UHC Dual Complete NC-S001 (PPO D-SNP) H1889-005-000

2026 Enrollment Request Form ¨ UHC Dual Complete NC-D001 (HMO-POS D-SNP) H5253-041-000

2026 Enrollment Request Form ¨ UHC Complete Care NC-28 (HMO-POS C-SNP) H5253-189-000

2026 Enrollment Request Form ¨ UHC Complete Care NC-27 (HMO-POS C-SNP) H5253-188-000

2026 Enrollment Request Form ¨ UHC Complete Care NC-25 (HMO-POS C-SNP) H5253-186-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage Patriot No Rx NC-MA02 (HMO-POS) H5253-040-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage Patriot No Rx NC-MA01 (PPO) H2001-103-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage Giveback from UHC NC-14 (HMO-POS) H5253-110-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage Giveback from UHC NC-13 (HMO-POS) H5253-105-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-26 (HMO-POS) H5253-187-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-24 (HMO-POS) H5253-185-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0022 (HMO-POS) H5253-038-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0021 (HMO-POS) H5253-037-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0019 (PPO) H2406-115-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0017 (PPO) H2406-098-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0016 (PPO) H2406-034-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0015 (HMO-POS) H5253-117-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0012 (HMO-POS) H5253-104-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0011 (HMO-POS) H5253-103-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0009 (HMO-POS) H5253-080-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0008 (HMO-POS) H5253-079-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0007 (HMO-POS) H5253-039-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0004 (PPO) H2001-102-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC NC-0001 (PPO) H2001-090-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage Access from Enrollment UHC NC-23 (PPO) H2001-084-000