Member ID Card - High Plains Health Plan

Need a new ID Card? Complete the form below and we’ll send you a new card as soon as possible. Cards are typically mailed within five business days. If you need an immediate PDF version of your ID Card, leave a comment and we’ll email you one.

Name

First

Last

Birth 4 Address

Date of Birth – Month

Date of Birth – Day

Date of Birth – Year

Name of Employer

Member Identification Method

Member ID
SSN (last 4 digits only)

Member ID or SSN (last 4 digits)

Phone

Number of Cards Requested

Where to mail the card to?

Employer
Member address on file
New member address (enter below)

Additional Comments or Requests