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
FORMS
Medicare Sales Appointment Confirmation FormMember Termination/Change Form (for groups only)Medicare Producer Formal Seminar Approval Form
PRESBYTERIAN GROUP BENEFIT INFORMATION
Procedural Forms - Quoting a Group with Presbyterian
Census FormLarge Group UMAFRate Request FormUMAF Medical Assessment Form, EnglishUMAF Medical Assessment Form, Spanish
Procedural Forms - Enrolling a Group with Presbyterian
Employee Action Form, EnglishEmployee Action Form, SpanishEmployee Action Form PIC/PHP, Spanish (enrollment /change /waiver)Employer Group Information SheetCOBRATransition of Care Form
Rate Increase Justification
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