Tips for Completing Your Enrollment Application
1. Fill out the application completely and sign where indicated.
- Incomplete applications cannot be processed until all information is obtained.
2. If you have Medicare Part B, include a copy of your Medicare card to avoid paying enrollment fees and medical care copayments (pharmacy copayments will still apply).
3. Be sure to include the enrollment fee payment, if applicable.
4. Make a copy of the application for your records.
- The US Family Health Plan will advise you of your enrollment status by mail before the effective date.
- If you have questions about the application, a US Family Health Plan representative will be glad to assist you.
5. Mail your application.
- If applications are received by the 20th of any month, enrollment becomes effective on the first day of the following month.
Last Modified:May 24, 2012
Contact
US Family Health Plan
1-800-74-USFHP
(1-800-748-7347)
www.usfhp.com