Health Forms

Forms Description Access Information

Enhanced Point of Service (POS) and Standard POS Plan Claim Forms

Complete a form only if you utilize out-of-network providers (in-network providers typically submit claims directly to the carrier)

UnitedHealthcare:
www.myuhc.com
1-800-577-8539

Traditional Indemnity Plan Claim Forms

Complete a form when you need to utilize medical benefits

UnitedHealthcare:
www.myuhc.com
1-800-577-8567

Health Maintenance Organization (HMO) Plan Forms

Contact your HMO about coverage, procedures and any required forms

Contact information is available:

  • On the back of your ID card, if you are currently enrolled in an HMO;
  • By visiting the Your Benefits Resources (YBR) website at https://digital.alight.com/nokia; or
  • By calling the Nokia Benefits Resource Center at 1-888-232-4111.

Mental Health and Chemical Dependency Coverage Precertification Forms
(Traditional Indemnity, Enhanced POS, and Standard POS participants)

Check with the carrier before receiving treatment to confirm whether you need to complete a precertification form

UnitedHealthcare Behavioral Health:
Enhanced and Standard POS:
www.liveandworkwell.com
1-800-577-8539
Traditional Indemnity:
1-800-577-8567

Prescription Drug Program Claim Forms
(Traditional Indemnity, Enhanced POS, and Standard POS participants)

Required when you need to use a pharmacy outside of the CVS Caremark network

CVS Caremark:
Caremark.com
1-800-240-9623

Prescription Drug Program Mail-Order Service Forms
(Traditional Indemnity, Enhanced POS, and Standard POS participants)

Required when mailing your initial request for filling up to a 90-day supply of medications through CVS Caremark Mail Service Pharmacy

CVS Caremark Mail Service Pharmacy:
Caremark.com/mailservice
1-800-240-9623

MetLife Dental Plan Claim Forms

Required only if you use a dentist outside of the MetLife network

MetLife:
www.metlife.com/mybenefits
1-888-262-4876
Company/Group Name: US-Nokia