indicates required information

  • 1 Current: Step 1
  • 2 Step 2
  • 3 Complete

Update your contact information

Quickly and easily update your contact information online. Please allow up to 7 days for changes to take effect. Contact customer service if you need assistance or have questions.
Provide your member information
Request changes
Change phone and/or email
Choose your plan type
Individual or group
Change permanent resident address
(P.O. Box not allowed)

If your state is not listed or if you are moving out of the country, do not proceed. Please contact customer service at 1-888-832-0075, 8 a.m. to 8 p.m., daily, Central and Mountain times. TTY hearing impaired users call 711

If you are moving out of the country, do not proceed. Please contact customer service at 1-877-838-3827, 8 a.m. to 8 p.m., daily, Central and Mountain times. TTY hearing impaired users call 711

 

Change mailing address (only if different from your permanent residence address)
Applicant or authorized representative signature

I understand that typing my name below means I have read and understand the contents of this form.

If this is submitted by an individual who is the authorized representative of the member and authorized to act on his/her behalf under the laws of the state where the enrollee lives, then this signature certifies that this person is authorized under state law to complete this form.