This form should be used by US- and Puerto Rico-based Employees ONLY. Use this form in Google Chrome or Microsoft Edge browsers. Global employees must open a case with HRdirect.

Who is this case for? Myself Someone Else

Employee Id:

Work Email:

Name:

Date of Birth:

Select a reason for case creation:

Preferred email (If different):

Preferred phone number:

Preferred Time of Contact:

Last day worked outside of the home:

(This means in one of our UHG worksites or care clinics, or in the field interacting with patients or members)