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1110 Main Street, Wheeling, WV 26003
enrollment@healthplan.org
1.800.624.6961 | Fax: 740.699.6163Enrollment/Change Form
Section A: General Information
Employer Numerous #Group LocationSection B: Employee
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What is change form - newly?
Change form - newly is a document used to update information that has changed recently.
Who is required to file change form - newly?
Any individual or entity whose information has changed recently is required to file change form - newly.
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Change form - newly can be filled out online or in person by providing updated information and supporting documentation.
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The purpose of change form - newly is to ensure that accurate and up-to-date information is on file.
What information must be reported on change form - newly?
The information that must be reported on change form - newly includes any updates to personal or business details.
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