If you are a current Individual Plan member and you want to make a benefit change to your current plan, add a dependent on your policy, or terminate your coverage please complete one of the following Individual Plan Member Forms.

 

  

Complete the Individual Plan Member Benefit Change Form when you are requesting a change to your current Individual Plan's benefits or requesting a change to another Individual Plan option.  If the plan you are requesting a change to has (1) a lower plan deductible than your current plan and/or (2) includes a higher prescription benefit and/or plan benefit than your current plan, you must also complete the Individual Plan Member Medical Questionnaire 

 

Complete the Individual Plan Member Add Dependent Form and the Individual Plan Member Medical Questionnaire if you wish to add a dependent to your policy. 

Note: You do not need to complete the Individual Member Medical Questionnaire for newborns added within 31-days from the date of birth, a newly adopted child or a child for whom a Subscriber has become a legal guardian within 31-days from the date of placement or the court order granting guardianship. 

 

Complete the Individual Member Voluntary Termination Form to terminate your policy or a dependent on your policy. 

 

The Presbyterian Customer Service Center is the best way to find more information about your healthcare coverage. Our Customer Service Ceter staff will answer all your questions promptly.