Update Contact 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
Change permanent resident address
(P.O. Box not allowed)

Your current coverage area includes [state_name].

If your new address is outside of your current coverage area or if you are moving out of the country, do not proceed. Please contact customer service at 1-877-376-2185, 8 a.m. to 8 p.m., daily, local time. 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.