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Member Primary Care Provider (PCP) Change Request Form Please complete this form with your provider if you want to change your PCP. Your provider will then send this form to Superior Healthily STAR+PLUS

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How to fill out member primary care provider

01

Obtain the member primary care provider enrollment form from the insurance provider.

02

Fill out the member's personal information such as name, date of birth, and insurance ID number.

03

Provide details of the chosen primary care provider including name, address, and contact information.

04

Sign and date the form, and make a copy for your records before submitting it to the insurance provider.

Who needs member primary care provider?

01

Anyone who has health insurance and wants to establish a primary care provider for regular medical care needs a member primary care provider.

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What is member primary care provider?

Member primary care provider is the main doctor or healthcare provider that a member chooses to see for routine check-ups and medical care.

Who is required to file member primary care provider?

Members are required to file their primary care provider with their insurance company.

How to fill out member primary care provider?

Members can fill out their primary care provider information on their insurance enrollment forms or through their online member portal.

What is the purpose of member primary care provider?

The primary care provider is responsible for coordinating the member's healthcare needs, providing preventive care, and managing chronic conditions.

What information must be reported on member primary care provider?

The information required typically includes the provider's name, contact information, specialty, and any relevant medical history.

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