UHC SC MAPD Enrollment Kit

2026 Enrollment Request Form ¨ UHC Nursing Home Plan SC-F001 (PPO I-SNP) H0710-053-000

2026 Enrollment Request Form ¨ UHC Medicare Advantage Patriot No Rx GS-MA01 (Regional PPO) R2604-005-000

2026 Enrollment Request Form ¨ UHC Dual Complete SC-V001 (PPO D-SNP) H2001-059-000

2026 Enrollment Request Form ¨ UHC Dual Complete SC-S2 (PPO D-SNP) H2001-075-000

2026 Enrollment Request Form ¨ UHC Dual Complete SC-S001 (PPO D-SNP) H2001-032-000

2026 Enrollment Request Form ¨ UHC Complete Care Support SC-7 (PPO C-SNP) H2001-076-000

2026 Enrollment Request Form ¨ UHC Complete Care Support GS-1A (Regional PPO C-SNP) R2604-002-000

2026 Enrollment Request Form ¨ UHC Complete Care SC-1 (PPO C-SNP) H2001-060-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage Patriot No Rx SC-MA01 (HMO-POS) H5322-043-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC SC-0006 (HMO-POS) H5322-044-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC SC-0005 (HMO-POS) H5322-040-000

2026 Enrollment Request Form ¨ AARP® Medicare Advantage from UHC SC-0004 (PPO) H2001-108