How do I file a UnitedHealthcare AARP claim?

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Member forms

Find commonly used forms and documents

View the links below to find member forms you can download, making it quicker to take action on claims, reimbursements and more. 

If you can’t find the form or document you’re looking for below, sign in to your member site to find more.

Sign in to see forms for your health plan

Download forms here

Reimbursement and claim forms

• Direct medical reimbursement form - digital form

  To request COVID-19 reimbursement, please select one of the COVID-19 Testing/Vaccine Administration reimbursement types. This form can also be used for foreign care, DME, physical therapy and other qualified services or purchases. Oxford members have the option to request reimbursement for vision services only.

  Note: This form is for individuals that currently have, or previously had, a UnitedHealthcare insurance plan and sign in using myuhc.com. This form cannot be used by UnitedHealthcare West, Expat, Empire or some other members with insurance through their employer or an individual plan.
  

• Direct member reimbursement form (pdf)
• Oxford NJ, CT, and ASO (any state) medical claim form (pdf)
• Oxford NY medical claim form (pdf)
• PA medical claim form - digital format (pdf)

Tax, legal and appeals forms

Form 1095-B is a form that may be needed for your taxes, depending on the law in your state. 

Most fully insured UnitedHealthcare members will not automatically receive a paper copy of Form 1095-B due to a change in the tax law. However, Form 1095-B will continue to be available on member websites or by request.

Here are the ways to get a copy of your Form 1095-B:

• Sign in to your health plan account to view and/or download and print a copy of the form
• Call the number on your member ID card or other member materials 
• Complete the 1095B Paper Request Form and email it to your health plan at the email address listed on the form

If you have questions about your Form 1095-B, contact UnitedHealthcare by calling the number on your member ID card or other member materials. 

Note: Complete and submit this form for appeals or grievances for medical or pharmacy services you received. This excludes UHC West, Oxford and some members with insurance through their employer or an individual plan. Before you start, make sure you have all applicable documents from your provider. Providing supporting documents will help with the appeal review.

California grievance forms for United Healthcare Benefit Plans of California

• English (pdf)
• Español (pdf)
• 中文 (pdf)

• Certificate of Coverage or Proof of Lost Coverage Form

  Use this form to request Certificate of Coverage (COC) document(s) when coverage is still active or to request Proof of Lost Coverage (POLC) document(s) when coverage is no longer active.

  This form is for individuals that currently have or previously had insurance through their employer or an individual plan through UnitedHealthcare and sign in using myuhc.com.

  This form should not be used by UnitedHealthcare West, Oxford, Expat, Empire or some members with insurance through their employer or an individual plan.

• POA/ROI form for individuals with insurance through their employer and UnitedHealth Group employees

  Use this form to authorize the release of your health information or to appoint someone to act as your representative with UnitedHealthcare. This form should not be used by Oxford members.

• POA/ROI form for individuals on a community plan

  Use this form to authorize the release of your health information or to appoint someone to act as your representative with UnitedHealthcare.

Plan and state specific forms

Choice, Choice Plus, Non-Differential ("Non-Diff" or "Options PPO"), Select and Select Plus, Core; Core Essentials Network, and Navigate continuity of care

• English (pdf)
• Español (pdf)
• 中文 (pdf)