United American Insurance Company: Branch Office Uaatwork Supply Order Form

UAatWork Supply Order Form
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0209
UNITED AMERICAN INSURANCE COMPANY

BRANCH OFFICE UAatWork SUPPLY ORDER FORM
3700 S. Stonebridge Drive, McKinney, Texas www.unitedamerican.com E-Mail: uaagentsupply@torchmarkcorp.com
PLEASE NOTE: Most materials are available online for immediate download (DOWNLOAD NOW) and may not available through Supply. Applications are available through state Compliance Sheets. Material availability may vary by state. Please refer to your state's Compliance Sheet or Product Approval Chart before ordering. STEP 1: Fill in the yellow and blue boxes below. All information is required. Please complete a separate UAatWork Supply Order Form for each state where you are licensed.
AGENT NUMBER
BRANCH NAME
BRANCH NUMBER
ORDER DATE
YOUR NAME
# LICS. AGENTS
STREET ADDRESS (REQUIRED FOR GROUND DELIVERIES)
SUITE
For which state you are requesting forms?
CITY
ZIP
E-MAIL ADDRESS
CELL PHONE
OFFICE PHONE
FAX
BOD
F4397 R0209
STEP 2: Enter the quantity your are requesting to the right of each item. Then e-mail the completed form as an attachment to uaagentsupply@torchmarkcorp.com. (From the "File" menu above, select "Send To", then select "Mail Recipient as Attachment".)
AGENT TRAINING MATERIALS

UAatWork Agent Manual F4341 UAatWork Section 125 Agent Reference Guide F4997 UAatWork New Business Workflow F5335 CS Section 125 Employer Implementation Manual F4500
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WORKSITE MARKETING ADVERTISING MATERIALS

UAatWork Presentation Folder F4340 UAatWork Enrollment Poster F4398 UAatWork Program Advertising Brochure F4435 UAatWork Section 125 Employer Brochure F4496 UAatWork Section 125 Employee Brochure F4497 UAatWork Print Ad - Products UAW-1 UAatWork Approach Letters USM-1 UAatWork Approach Letters USM-2 UAatWork Approach Letters USM-3 UAatWork Approach Letters USM-4
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CASE SUBMISSION FORMS

New Payroll Deduction Case (After-Tax) PDF Packet New Section 125 Case (Pre-Tax) PDF Packet Amend an Exisiting Section 125 Case (Pre-Tax) PDF Packet The PDF Packets above include all relevant forms, which are also listed below: Acceptance of Payroll Deduction F4348 B Plan Adoption Agreement EIM-001 Salary Reduction Form EIM-002 Points to Remember EIM-003 Premium Reduction Amendment EIM-004 Payroll Deduction Authorization F4349 Payroll Deduction Cancellation F4350 New Business Transmittal Form F4351 Request for Contingent Guarantee Issue F4715 Consumer Form 3728
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REQUIRED FORMS
Life and Health Privacy and Disclosure Booklet UAPDI F5616 HIPAA Release Authorization F3978 Rated Premium Rider Worksheet U-1280 WSM
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PRODUCT MATERIALS
Where approved, applications and other required forms can be downloaded from your state's Compliance Sheet. Select your state from the drop down menu displayed on the web page.
UAMG
Application UAMG[XX] Optional Dependent Form UAMG-ODF[XX] Health Rate Card F4434[XX] Foundation (MMGAP/R-MMGAP-HO) Product Brochure F6546[XX] Outline of Coverage DS-MMGAP[XX] Marketplace Bulletin F6608 WSM MMGAP
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UAMM
Application UAMM[XX] Optional Dependent Form UAMM-ODF[XX] Health Rate Card F4434[XX] Life Rate Book F4702[XX] Foundation (MMGAP/R-MMGAP-HO) Product Brochure F6546[XX] Outline of Coverage DS-MMGAP[XX] Marketplace Bulletin F6608 WSM MMGAP Life - 20 Year Renewable Term & Term to 100 (UATPTL/UATGC) Product Brochure F6550 Marketplace Bulletin F6604 WSM UAPTL Marketplace Bulletin F6605 WSM UAPTGC
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UAGP
Application UAGP[XX] Optional Dependent Form UAGP-ODF[XX] Health Rate Card F4434[XX] FLEXguard (GSP2) Product Brochure F4631[XX] Outline of Coverage DS-GSP2[XX]R
UACB PRODUCT MATERIALS

Application UACB[XX] Optional Dependent Form UACB-ODF[XX] Health Rate Card F4701[XX] Life Rate Book F4702[XX] Accident Compensation (UA-250) Product Brochure F4432[XX] Outline of Coverage DS-UA250 Cash Cancer (CANB) Product Brochure F4430[XX] Outline of Coverage DS-CANB[XX] Cancer Expense (CAXC) Product Brochure F4703[XX] Outline of Coverage DS-CAXC[XX] Critical Illness (CILS) Product Brochure F4431[XX] Outline of Coverage DS-CILS[XX] Life - 20 Year Renewable Term & Term to 100 (UATPTL/UATGC) Product Brochure F6550 Marketplace Bulletin F6604 WSM UAPTL Marketplace Bulletin F6605 WSM UAPTGC
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UAHI PRODUCT MATERIALS

Application UAHI[XX] Optional Dependent Form UAHI-ODF[XX] Health Rate Card F4387[XX] Preferred Series (GSP1) Product Brochure F4342[XX] Outline of Coverage DS-GSP1A[XX] / DS-GSP1B[XX] Deluxe Series (HSXC) Product Brochure F4343[XX] Outline of Coverage DS-HSXC2500[XX] / DS-HSXC7500[XX]
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Surgical Expense Series (SSXC) Product Brochure F4344[XX] Outline of Coverage DS-SSXC[XX] Surgical Medical Series (SMXC) Product Brochure F4345[XX] Outline of Coverage DS-SMXC[XX] Protector Series I (HMXC) Product Brochure F4346[XX] Outline of Coverage DS-HMXC[XX] Protector Series II (HIXC) Product Brochure F4347[XX] Outline of Coverage DS-HIXC[XX]
UA PARTNERS DISCOUNT MEDICAL PLAN FORMS

Partners Plus Worksite Enrollment form F6692WS UA Partners with Provider Network Option Worksite Enrollment F6693W2 UA Partners Worksite Enrollment Form F6694WS UA Partners Stand Alone Worksite Enrollment Form F6696WS NetConnect Worksite Enrollment Form F6697WS UAatWork UA Partners Enrollment Form F4300( R) Mail Order Program Agent Guide F4505-T UA Partners 24-Hour NurseLine Pamphlet F2940 UA Partners Travel Assist Pamphlet F2941
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United American Insurance Company: Branch Office Uaatwork Supply Order Form

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UAatWork Supply Order Form