Claim Your UHC HPN Medicaid Reward

Making positive choices for you and your family is rewarding.

How to claim your reward?

Complete the entire form.¹ Once you submit the form, we will make sure you met the requirements and mail your reward.

Claim Your UHC HPN Medicaid Reward

What type of care did you receive?

$50 follow-up visit within 7 days after an emergency room visit for mental illness $25 follow-up visit within 30 days after an emergency room visit for mental illness

Member is eligible for one reward after an emergency room visit.

I received all of the recommended visits.

Yes No

Date of last service:

Location/clinic name:

Member information:

Member’s full name:

Birthdate:

If under 18, parent/guardian’s full name:

HPN member ID (11-digit number on the front of your health plan ID card):

Email address:

Re-enter email address:

Primary phone:

Mailing address:

City:

State:

Zip code:

Country:

All fields are required to process your application and mail your reward. If you have any questions or need help filling out this form, please call 702-632-5601 or toll-free 1-800-962-8074, TTY 711.

¹To be eligible for this benefit, recipient must be an active member of UnitedHealthcare Health Plan of Nevada Medicaid. UHC HPN Medicaid will verify visits, vaccines and screenings before we email the member reward. Member reward takes six to eight weeks for processing. Program is subject to change. We will send the member reward to the email address on the form. Members are responsible for lost or stolen cards.

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Claim Your UHC HPN Medicaid Reward

How to claim your reward?

Claim Your UHC HPN Medicaid Reward

Member information: