Medical Weight Loss Enrollment Form

Thank you for your interest in the Medical Weight Loss (MWL) program. Please check your eligibility before completing this form. Once you submit this form, one of our Care Navigators will reach out to get you started.

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Do you consent to receiving unencrypted emails and communications regarding your Medical Weight Loss program?*

If you do not see your group number below, call the number on your card to determine eligibility or visit United Well-being to explore other well-being resources available to you.



*Child Dependents 18 years or older are not eligible for Medical Weight Loss under the HSA Plan – Union, OptumCare EPO Plan – Union and the Surest Copay Plan – Union.

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