Presbyterian Health Plan Member Forms

If you are a current individual plan member, and you want to change your address, add a newborn child (within 31 days of the child's birth), or terminate coverage for a dependent, you must complete the following Add/Change form:

• Add/Change/Term Form (.pdf)

If you wish to add a dependent to your policy (other than a newborn child within 31 days of the child's birth, you will need to submit the questionnaire below in addition to the Add/Change form.

• Medical Questionnaire (.pdf)

Presbyterian Member Services is the best way to find more information about your healthcare coverage. Our Member Services staff will answer all your questions promptly.

• Request more information