UnitedHealthcare Foreign Providers Claim Form

For employees, retirees, covered dependents, and COBRA participants who are enrolled in a UnitedHealthcare Medical Plan.

This form is used to file a claim for medical expenses incurred by you when you (or your covered dependents) use the services of a physician or other healthcare provider in foreign country.

Instructions

If possible, ask the provider of service to write the bill in English and convert the currency to U.S.Dollars. If the provider of service is not able to present the bill or claim in English and U.S.Dollars, do not perform the translation or currency exchange yourself. United Healthcare will provide these services for you. Your international claim payment information is available on www.myuhc.com Please use this as a resource when checking the status of your claim.
Carefully review Section 3 - Important Information for Submitting your Medical Claim before filing the claim.

Completed claim forms should be mailed to:

UnitedHealth Group
International Claims
PO Box 740817
Atlanta, GA 30374