Open Enrollment for 2016 has ended, but Special Enrollment is available year-round.
If you have experienced a major life event within the past 60 days – such as loss of healthcare coverage from another plan, getting married, having a baby, or moving – you may qualify for special enrollment. Enroll online or download and fill out the enrollment form located below and follow the instructions.
Online Special Enrollment
To mail or fax the enrollment form, please select the link to open the application or right click to save to your desktop. NOTE: If you are on a public computer, please use best practices for data security.
2016 Application for Individual and Family
Dental coverage is now available at a low monthly cost for Presbyterian Individual and Family Plan members.
Authorization for Dental Plan
Fill out the form(s), save the PDFs for your records, then print and sign a copy. Send a signed copy to us:
Presbyterian Health Plan
P.O. Box 27489
Albuquerque, NM 87125-7489
or TTY 711
for assistance, Monday through Friday, 8 am to 5 pm.
Note: To be eligible for health coverage, you and your dependents must be US citizens, US nationals, or lawfully present immigrants. For help, visit Healthcare.gov to learn more.
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