In This Section
Member / Resources & Self Service / Change Your Primary Care Physician

Change Your Primary Care Physician (PCP)

Your relationship with your Primary Care Physician (PCP) is very important. Enrollees of either HMO or POS plans may change their PCP at any time by either submitting the form below or calling Member Services at 1-800-996-8701. Please note that you must continue to see your current PCP until your request to change has been processed. You will receive a new ID card, which lists your new PCP and the effective date of the change.



*Member Number (on ID Card)  
Group Number
*Member First Name  
*Member Last Name  
Middle Initial
*Member Address  
*City  
*State
*Zip  
*Email Address    
*Relationship
(if Other)
If Changing Due to a Quality of Care issue, please select an option from the drop down menu as the reason you are changing

New Primary Care Physician
*Physician's Name  
*PCP Code  
*Requested Effective Date of Change    
State
Zip
Phone Number