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(DO NOT STAPLE) Employee Enrollment Form UnitedHealthcare Insurance Company UnitedHealthcare of Texas, Inc. National Pacific Dental, Inc.
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Document Date: 2014-10-03 19:12:14


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File Size: 218,08 KB

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Company

Texas Inc. / UnitedHealthcare Insurance Company / Dental / National Pacific Dental Inc. / STD LTD / /

IndustryTerm

medical carrier name / appropriate management / insurance plan / tobacco products / reproductive health services / /

MedicalCondition

sexually transmitted disease / HIV/AIDS / illness / mentally disabling injury / /

MedicalTreatment

psychotherapy / /

Organization

End dt____/____/____ Hourly* Salary* Union / For UnitedHealthcare Health Maintenance Organization / For court / Medicare / /

Position

Physician / care physician / representative / Gynecologist / Dentist / pharmacy benefit manager / employer representative / No Physician / Obstetrician / /

Technology

cellular telephone / /

SocialTag