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Important documents

On this page you'll find samples of the following important medical plan documents. Please use the information here as a general reference. 

  • Certificate of Coverage
  • Certificate of Coverage (California)
  •  Schedule of Benefits (California)
  • Prior Authorization Guides

Sample Certificates of Coverage

These documents shown here are sample Certificate of Coverage (COC) for members with a UnitedHealthcare health insurance plan. Please use this information as a general reference. 

Once you are a member, you’ll find your plan specific COC on myuhc.com. You can also obtain your COC from your employer.

Sample California Certificates of Coverage

The materials shown here are sample California Certificates of Coverage showing covered health services for UnitedHealthcare health insurance plan members. Please use this information as a general reference. 

Once you are a member, you’ll find your plan specific COC on myuhc.com. You can also obtain your COC from your employer.

2017 Certificate of Coverage (COC)

2016 Certificate of Coverage (COC)

Sample California Schedule of Benefits

The materials shown here are sample Medical Schedule of Benefits documents showing covered health services for UnitedHealthcare health insurance plan members.

Please use this information only as a general reference.

Employer Prior Authorization Guides

These sample documents are for employer groups with 51 or more employees with plan effective date on or after January 1, 2022 

The employer guides provided below provides directions and highlights prior authorization (PA) requirements which may apply to either network or out-of-network services, or both. Please review the prior-authorization document that applies to your state of residence.