PCP Change Form - Univera Healthcare: Fill out & sign online

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Click ‘Get Form’ to open the PCP Change Form in the editor.
Begin by entering today’s date at the top of the form. This helps track when the request is made.
Fill in your Member ID# and your name clearly in the designated fields. If applicable, include your parent or guardian's name as well.
Indicate the reason for changing your Primary Care Provider (PCP) in the provided section. Be concise but clear.
Sign the form where indicated, ensuring that either you or your parent/guardian provides a signature if necessary.
Enter the name of your new Medical PCP and OB/GYN in their respective fields.
Specify the effective date of change, which should be set for the first day of the upcoming month.
Once completed, fax the form to Customer Service using one of the provided numbers based on your plan type.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

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Who is the parent company of Univera Healthcare?

Univera Healthcare is part of The Lifetime Healthcare Companies, a family of companies that now provides health insurance coverage to about 1.5 million people across 39 counties of New York state.

What is the phone number for Univera insurance?

If you have additional questions, please call Customer Service at (800) 920-8889 or (800) 337- 3338.

What does Univera cover?

All of our plans offer access to top-quality doctors and hospitals, plus coverage for doctor visits, prescription drugs, urgent care, hospitalization, and free preventive care. We can help you get coverage. Visit our Resource Centers for help in person.

Is Univera Healthcare Medicaid?

Univera Healthcare MyHealthSM is a Medicaid program sponsored by New York State. It provides free or low-cost health insurance, if youre eligible.

What is the phone number 877-842-3210?

UnitedHealthcare Network 1. Call the Provider toll-free number: 877-842-3210 2. Identify yourself as a provider by entering the Tax ID (this does not have to be a TIN that UHC already knows) 3. The main menu option you want is Healthcare Professional Services (or the number 4 on the telephone keypad) 4.