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Harvard pilgrim enrollment form

Harvard pilgrim enrollment form 2026

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The document is an Enrollment/Change Form for the Harvard Pilgrim HMO, used for various purposes such as enrolling new members, changing coverage, or terminating membership. It includes sections for personal information, dependent details, primary care physician selection, and consent for medical information sharing. The form emphasizes the importance of selecting a primary care physician and outlines the process for submitting changes or cancellations.

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Click ‘Get Form’ to open the Harvard Pilgrim Enrollment Form in our editor.
Begin by checking the appropriate reason for submission at the top of the form. Options include 'New Hire', 'Loss of Insurance', and 'Annual Open Enrollment'.
Fill in your Contract/ID Number, Group/Company Name, and Date of Hire in the designated fields.
Provide your personal information including Employee Name, Address, and Telephone numbers. Ensure accuracy as this information is crucial for processing.
List all dependents you wish to enroll by filling out their names, dates of birth, and selecting a Primary Care Physician (PCP) for each member.
If applicable, indicate any changes such as name or address changes and attach necessary documents as required.
Review all entries for completeness and accuracy before signing. Each adult must sign where indicated.

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

What happened to Harvard Pilgrim Health Care?

Office of Human Resources Tufts Health Plan and Harvard Pilgrim Health Care are now combined into a single health and well-being organization: Point 32 Health. The following outlines important information about the transition.

Does Harvard Pilgrim cover gym memberships?

You must be currently enrolled in Harvard Pilgrim at the time of reimbursement. Fitness facility membership or virtual fitness subscription must be for at least four months in a current calendar year. Restrictions apply, and reimbursement is not available to all members.

Are Harvard Pilgrim and UnitedHealthcare the same?

We have a strategic business and marketing partnership with UnitedHealthcare, an industry leader in health and well being, so that we can offer you and your employees seamless, nationwide networks and benefit coverage. Coverage underwritten or administered by HPHC Insurance Company, Inc.

What is Harvard Pilgrim called now?

In 2021, Harvard Pilgrim Health Care, Tufts Health Plan and our family of companies combined to create Point32Health. Today, Point32Health is a leading not-for-profit health and well-being organization, delivering a better health care experience to our members and the communities we serve.

Who did Harvard Pilgrim merge with?

Tufts Health Plan and Harvard Pilgrim Health Care are now combined into a single health and well-being organization: Point 32 Health.

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