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Unavailable transactions

For these transactions, complete a Priority Health enrollment form (353KB PDF) and attach supporting documentation if needed.  

  • Medicare plan enrollments or disenrollments
  • Ancillary-only (dental, vision, disability) enrollments without medical coverage
  • Open enrollment period enrollments or disenrollments
  • Add dependent over age 19
  • Add dependent due to:
    • Loss of coverage
    • Adoption
    • Disability
    • Ward of a court-appointed guardian
  • Change Social Security number
  • Change to full-time/part-time

For this transaction, complete a Member Change Form (44KB PDF):

  • Change class