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  1. Click ‘Get Form’ to open the 18882992070 document in the editor.
  2. Begin by filling out SECTION 1, starting with the Deceased’s Name and Address. Ensure all details are accurate.
  3. Provide the Name of Insured Employee, their Social Security Number, and Group Policy Number. This information is crucial for processing your claim.
  4. Complete the remaining fields in SECTION 1, including dates of birth and death, cause of death, and your relationship to the deceased.
  5. Attach any required documents such as a Certified Death Certificate and police reports if applicable. Use our platform's attachment feature for convenience.
  6. Once you have filled out SECTION 1 completely, submit it along with any attachments to your Employer for completion of SECTION 2.

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2018 4.8 Satisfied (107 Votes)
2015 4.4 Satisfied (63 Votes)
2014 4.3 Satisfied (165 Votes)
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Golden Rule Insurance Company, which underwrites Short Term Medical insurance products, is rated A (Excellent) by A.M. Best - a mark of financial strength and stability.
For questions about this document, please contact Customer Service at 1-866-272-1967. (TTY users should call 711).
Access health plan details on the UnitedHealthcare app and myuhc.com Get the UnitedHealthcare app, sign in or register for a member account to manage your health plan on your schedule. See your benefits, find network doctors, view and pay claims and more.
UNITEDHEALTHCARE INSURANCE COMPANY Administered by Solstice Healthplans of Texas, Inc.
UnitedHealthOne is a brand used to represent several companies under UnitedHealthcare that provide products and services designed specifically for individuals and families.

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UnitedHealthOne is a brand representing UnitedHealthcare-branded individual insurance products underwritten by Golden Rule Insurance Company. UnitedHealthcare and Golden Rule have been serving the insurance needs of individuals and families for over 75 years.