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This form is completed by employers that want to offer HealthShare™ coverage to their employees. The employer application helps determine the employer's program eligibility.
Click here to open the form. |
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Complete this form along with the Employer Application to determine which employees may be eligible for HealthShare™.
Click here to open the form.
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Change and Cancellation Form |
Use this form for:
- An addition of a dependent
- Address or contact information updates
- Changing your Primary Care Physician (PCP)
- Requesting a new member ID card
- Changing your program option
- Terminating Coverage
Click here to open the form. |
