Complete this form to either enroll or update your PEHP Medical, Dental and Vision coverages. The form should be sent to PEHP directly at the address listed on the form along with any required documents as needed.
For changes effective 7/1/20:
Complete this form to either enroll or update your PEHP Medical, Dental and Vision coverages. The form should be sent to PEHP directly at the address listed on the form along with any required documents as needed.
For changes effective 7/1/20: