Our Enrollment Process
Provider Partners Health Plans is an insurance product sold through licensed and appointed agents. The agent will complete a “Scope of Appointment” form and detail what will be discussed during the sales presentation. After that, the agent will discuss various elements of the plan with a specific focus on eligibility, service area, covered services, and cost-sharing.
If you want to enroll after the presentation, you will complete an Enrollment Form and return it to the agent for processing.
Once the enrollment form is processed, you will receive a welcome packet with a confirmation notice stating your effective date of enrollment and your plan ID card along with information on how to access your Evidence of Coverage, formulary, provider directory, and pharmacy directory.
Downloadable 2022 Enrollment Forms:
- Provider Partners Advantage Enrollment Form
- Provider Partners Advantage Enrollment Form (Spanish)
- Provider Partners Community Enrollment Form
- Provider Partners Community Enrollment Form (Spanish)
These enrollment forms are available for download. Once completed and signed, please mail or fax to the contact information below.
Provider Partners Health Plans
785 Elkridge Landing Rd Suite #300
Linthicum Heights, MD 21090
Fax Number: 1-844-632-2216
If you have additional questions, please contact our Member Services number at 1-800-405-9681 for additional information. (TTY users should call 711). Hours are 8:00 A.M. to 8:00 P.M., seven days a week from October 1 through March 31; 8:00 A.M. to 8:00 P.M. Monday to Friday from April 1 through September 30.
Page Last Updated: 10/15/2021