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Colorado Custom Order Request Form

Please note that all required fields must be completed. Click on the “Submit” button to proceed to the confirmation page indicating that your order is complete.

For Bulk/Generic enrollment kits, do not use this form, please complete the Bulk/Generic enrollment kit request form instead.

If you are experiencing issues completing this form, please email coloradomaterials@uhc.com.

* Denotes a required field.

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PLEASE BE AWARE

Any orders placed after 12pm MST may be processed on the next business day. We require 7-10 business days for processing and ground shipping. If this is a RUSH request, please confirm if you are able to pick up. We are unable to overnight paper kits. Last minute requests (24-48 hour TAT) will be processed electronically only.

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 Adjusted Community Rating (ACR) (1-100 Subscribers)
 Non-Adjusted Community Rating (Non-ACR) (101+ Subscribers FI, and All Savers)

These are the standard items included in
UnitedHealthcare Fully Insured kits: 

  • Enrollment Form  
  • Welcome Brochure 
  • Plan Highlights 
  • Applicable Specialty Plan(s) and Insert(s)   

These are the standard items included in
All Savers kits:

  • Enrollment Form
  • Wellness Resources Brochure
  • Plan Highlights
  • Applicable Specialty Plan(s) and Insert(s)   
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 UnitedHealthcare Fully Insured
 All Savers®
 ACEC
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 Colorado Doctors Plan
 Navigate
 Charter
 None

Please note: Effective 3-13-20 we will only be able to offer electronic enrollment kits, until further notice.

The Colorado sales office has adopted practices to achieve “social distancing” to help minimize the opportunity for contraction or spread of COVID-19. With that, we will not distribute paper kits until further notice. We appreciate your understanding.

Please contact your Field Account Manager or our kitting mailbox with any questions: coloradomaterials@uhc.com.

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 Electronic

Kit Language

 
 English
 Spanish

Plan 1

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Plan 2

 
 

Plan 3

 
 

Plan 4

 
 

Plan 5

 
 

Plan 6

 
 
 
 
 
 
 

Special Instructions/Additional Notes regarding your order:
(i.e. Additional medical plans, Optum Health Bank, state application other than CO.)

Delivery Information

Please provide your contact information:

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Electronic kits will be delivered to above email address. If you would like us to deliver to another person, please include email address(es) in the additional spaces below.

Additional Email Addresses

 
 
 
 


If you are experiencing issues completing this form, please email coloradomaterials@uhc.com.