Coverage That Makes Sense

Presbyterian Health Plan, Inc. wants to help. Below are documents that are frequently requested. If you can't find what you are looking for, please contact us.

General

• Presbyterian Senior Care Table of Commission Rates
• Producer Commissions Authorization/Agreement for Direct Deposit

Forms

• Medicare Sales Appointment Confirmation Form
• Member Termination/Change Form (for groups only)

Presbyterian Group Benefit Information

Procedural Forms - Quoting a Group with Presbyterian

• Census Form
• Large Group UMAF
• Rate Request Form
• UMAF Medical Assessment Form, English
• UMAF Medical Assessment Form, Spanish

Procedural Forms - Enrolling a Group with Presbyterian

• Employee Action Form, English
• Employee Action Form, Spanish
• Employee Action Form PIC/PHP, Spanish (enrollment /change /waiver)
• Employer Group Information Sheet
• COBRA
• Transition of Care Form

Individual Plans

• Presbyterian's Individual and Family Plans

Questions?

• Call our knowledgeable associates on our Employer/Producer hotline:
• 505-923-5656 or 1-866-246-9877