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Plan Materials Order Form for GIC Coordinators

Use our online order form to request the Plan materials you need. Just complete the information in the form below, then select the item and quantity you would like to order. If you want to request more than one item, click the "back" button after making each request.

Benefit Descriptions – In addition to ordering Plan materials through the form below, you can also view and print benefit descriptions from this web site. These descriptions provide detailed information about benefits and coverage for specific services – such as outpatient lab services and preventive care – that are available under the UniCare State Indemnity Plan.

All information is required.

Your Name:
Your Agency:
Street Address
City, State, Zip:
Daytime Phone #: - -
Your Email Address:
Select Item You Are Requesting:
Enter the Quantity:

 

Please type the following security code in the box below. Using this code makes this transaction even more secure.


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For self-funded plans, claims are administered by UniCare Life & Health Insurance Company. © 2018 UniCare