Ready to Enroll? Here are the following form to enroll into the AHP. Please note that items 3 -4 and 5-6, you only need to complete the applicable form depending on your nature of business.
If you currently are enrolled with UHC, you do not need to complete #9 or #10.
- WMC Insurance Membership Form
- Employer Certification for Manufacturing
- Employer Certification for a Wholesale or Retail Group
- WMC-Service Fee Agreement
- WMC Employer Participation Agreement for a Manufacturing Group
- WMC Employer Participation Agreement for a Wholesale or Retail Trade Group
- WMC Billing Collection Service Fee Agreement Signed
- Participation Certification
Please assemble the following completed documents and send to your UHC Representative for processing.
Please let Robert Baker know if you have any questions on the forms or process at firstname.lastname@example.org or 608-572-0258.