Paper Enrollment Application Submission

Effective immediately, use the following instructions to submit paper enrollment applications for all MA and PDP plans in the UnitedHealthcare® Medicare Solutions portfolio, excluding UnitedHealthcare
Senior Care Options (SCO) and People’s Health plans.

Paper Enrollment Application Submission

Choose ONE Submission Method: Secure Email (preferred) OR Fax

Secure email is the preferred submission method. Agents must be able to convert the paper enrollment application to PDF and use UnitedHealthcare’s secure email.

Email:

  1. Convert each enrollment application to a separate, non-editable PDF (no greater than 15 MB). Do not scan/convert multiple applications into a single PDF.
  2. Attach PDF to email (email must not exceed 15 MB).
  3. Make sure the HIPAA confidentiality statement will appear on the recipient’s email. (Refer to Agent Guide for sample statement.)
  4. Send via UnitedHealthcare’s secure email to [email protected]. Failure to send via UnitedHealthcare’s secure email may result in corrective and/or disciplinary action
      1. Note: Request access to UnitedHealthcare’s secure email by emailing your request to the Producer Help Desk at [email protected]. Do not send an enrollment application to the PHD with the request. The PHD will send a secure email in reply, which will enable you to access and register to use UnitedHealthcare’s secure email service. Hint: Bookmark UnitedHealthcare’s secure email service for easy future access.
  5. After emailing an enrollment application, you will immediately receive an email from [email protected] that confirms your email was delivered.
  6. Expect a confirmation email (1-4 hours) with a listing of the file(s) received for processing.
      1. Note: Email confirmation service will not be available until Sept. 20, 2019.

Fax:

A fax coversheet with the HIPAA confidentiality statement must be used on each fax submission. (Refer to the Agent Guide for a sample statement.)

Regular Processing Fax Number
Most paper enrollment applications may be faxed to 1-888-950-1170. Do NOT fax enrollment applications for plans that require restricted processing to this number. Prior to faxing an enrollment application, check the current list of restricted plans to ensure that you use the correct fax number.

Restricted Processing Fax Number
Enrollment applications for some plans must be processed in the United States (i.e. on-shore). Prior to faxing an enrollment application, check the current list of restricted plans to ensure that you use the correct fax number. When faxed, paper enrollment applications for the following plans must be sent to 1-888-950-1169.

Restricted Plans (effective 9/9/2019)
As of Sep. 9, 2019, paper enrollment applications for the following plans must be faxed to 1-888-950-1169:
AZ: H0321-002 and -004
AZ: H5008-012
NJ: H3113-005
TN: H0251-002, -004, and -005

Restricted Plans (effective 12/26/2019)
As of Dec. 26, 2019, paper enrollment applications for the following plans must be faxed to 1-888-950-1169:
AZ: H0321-002 and -004
AZ: H5008-012
FL: H1045-012, -038, and -039
FL: H1889-001
FL: H5420-006
FL: R0759-003
GA: H2228-004
GA: H5322-030
GA: R2604-004
NJ: H3113-005
TN: H0251-002, -004, and -005
TX: H2228-041
TX: 4514-001
TX: H4517-003, -004, -005, and -015
TX: H4590-020, -022, and -033
TX: H5322-025 and -026
TX: R6801-011

Paper Scope of Appointment Forms

LEAN eSOA
Electronic Scope of Appointment (eSOA) became available in LEAN Sept. 7, 2019. Agents are strongly encouraged to use eSOA – in-person or via remote digital signature, whenever possible.

Paper SOA Submission Change
Effective Sept. 7, 2019, agents must not submit paper SOA forms to UnitedHealthcare. Agents must continue to retain paper SOA forms for 10 years from consumer signature date and make them available upon request.

Do NOT fax or email paper SOA forms to any fax number or email address used to submit paper enrollment applications. Do NOT submit a paper SOA form with an enrollment application.

Helpful Hints

Consider these recommendations to avoid inconvenience and delay in enrollment application processing:

  • Use LEAN electronic enrollment applications whenever possible. Refer to Jarvis / Knowledge Center / Training for LEAN resources and training.
  • Request UnitedHealthcare secure email access, so you are ready to email applications without delay.
  • Reprogram your fax machine to the new number (and delete all obsolete numbers).
  • Click here for a complete list of paper enrollment application submission instructions, including instructions for People’s Health, UnitedHealthcare Senior Care Options, and Medicare Supplement Insurance Plan

Questions

For questions related to the changes to the paper SOA submission policy, email [email protected].
For questions related to LEAN, eSOA, or submitting paper enrollment applications, contact the Producer Help Desk at [email protected] or 888-381-8581.

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