Request a UCare Connect information kit

Please complete the form below to request your free information kit.

First Name

Last Name

Address

City

State

Zip Code

County

Phone

Name of Requestor (if different from above)

How many packets would you like to receive?

How did you hear about UCare Connect?

Are you already enrolled in a UCare health program? Yes No

Are you at least age 18 or under age 65? Yes No

Do you have Medicaid (Medical Assistance)? Yes No

Do you have a certified disability or developmental disability? Yes No

By providing my phone number, I give permission for a licensed UCare Agent to contact me.

Questions?