Documents & forms

2026

UC High Option Supplement to Medicare

UC High Option Supplement to Medicare 2026 Benefit Booklet [PDF]

UC High Option Supplement to Medicare 2026 Medical Plan Benefits Summary—English [PDF]

UC High Option Supplement to Medicare—Navitus 2026 Evidence of Coverage [PDF]

UC High Option Supplement to Medicare—Navitus 2026 Medicare Part D Formulary [PDF]

UC High Option Supplement to Medicare—Navitus MedicareRx 2026 Summary of Benefits [PDF]

 

UC Medicare PPO

UC Medicare PPO 2026 Benefit Booklet [PDF]

UC Medicare PPO 2026 Medical Plan Benefits Summary—English [PDF]

UC Medicare PPO—Navitus 2026 Evidence of Coverage [PDF]

UC Medicare PPO—Navitus 2026 Medicare Part D Formulary [PDF]

UC Medicare PPO—Navitus MedicareRx 2026 Summary of Benefits [PDF]

UC Medicare PPO—Navitus MedicareRx 2026 Pharmacy Directory [PDF]

 

UC Medicare PPO without prescription drugs

UC Medicare PPO w/o Prescription Drugs 2026 Benefit Booklet [PDF]

UC Medicare PPO w/o Prescription Drugs 2026 Medical Plan Benefits Summary—English [PDF]

 

Navitus MedicareRx 2026 Pharmacy Directory [PDF]

Forms

Authorization of Release of Personal and Health Information [PDF]

International Medical Claim Form [PDF]

Medical Claim Form [PDF]

Prescription Drug Claim Form [PDF]

Prescription Drug International Claim Form [PDF]

2025

UC High Option Supplement to Medicare

UC High Option Supplement to Medicare 2025 Medical Plan Benefits Summary—English [PDF]

UC High Option Supplement to Medicare 2025 Medical Plan Benefits Summary—Spanish [PDF]

UC High Option Supplement to Medicare 2025 Benefit Booklet [PDF]

UC High Option Supplement to Medicare—Navitus 2025 Evidence of Coverage [PDF]

UC High Option Supplement to Medicare—Navitus 2025 Medicare Part D Formulary [PDF]

UC High Option Supplement to Medicare—Navitus MedicareRx 2025 Summary of Benefits [PDF]

 

UC Medicare PPO

UC Medicare PPO 2025 Benefit Booklet [PDF]

UC Medicare PPO 2025 Medical Plan Benefits Summary—English [PDF]

UC Medicare PPO 2025 Medical Plan Benefits Summary—Spanish [PDF]

UC Medicare PPO—Navitus 2025 Evidence of Coverage [PDF]

UC Medicare PPO—Navitus 2025 Medicare Part D Formulary [PDF]

UC Medicare PPO—Navitus MedicareRx 2025 Summary of Benefits [PDF]

 

UC Medicare PPO without prescription drugs

UC Medicare PPO w/o Prescription Drugs 2025 Benefit Booklet [PDF]

UC Medicare PPO w/o Prescription Drugs 2025 Medical Plan Benefits Summary—English [PDF]

UC Medicare PPO w/o Prescription Drugs 2025 Medical Plan Benefits Summary—Spanish [PDF]

 

Navitus MedicareRx 2025 Pharmacy Directory [PDF]