About
WCI
Membership
Benefits
Employer
Services
Human Resource Development
Supervisory Development
Onsite or Virtual Training
Employment Surveys
Safety Services
Recovery Friendly Workplaces
DynaMetrics (PDP)
Affirmative Action Plans
Healthcare
Alternatives
Upcoming
Training
Member Login
Menu
Home
About WCI and Contacts
Affirmative Action Plans
Conferences
Employers' Blog
Healthcare Alternatives
Employment Surveys
HR Recertification Options
Human Resource Development
Join WCI
Membership Benefits
NC Workforce Development Coalition
Onsite or Virtual Training
PDP Services
Request Member Access
Safety Services
Supervisory Development
Training Schedule (all)
Member Access Only
HR Answers Now
Member Hotline
Resource Links
HR Quick Surveys
Video Library
Calendar
+1 (800) 621-2685
[email protected]
Home
Exclusive Healthcare Savings
Family Health Insurance through Universal Unilink
Family Health Insurance through Universal Unilink
Please complete this form for EACH family member you'd like a quote for.
UU - Family Questionnaire
Employee's Name:
*
Employee's Company Name:
*
Family Member's First and Last name:
*
Family Relationship to Employee:
*
Spouse
Child
Age:
*
Height:
*
Weight:
*
Smoker?
*
Yes
No
Prescription Drugs:
*
Surgeries (list with dates and outcomes):
*
2 Town Square Blvd, Suite 370, Asheville, NC 28803
+1 (800) 621-2685
[email protected]