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Step Four: Send Us Your Enrollment Form

Go to Step 1: Choose a plan
Go to Step 2: Read the eligibility and enrollment information
Go to Step 3: Print an enrollment form
Complete Step 4: Sign your enrollment form
and mail it to:

        Priority Health, MS 1125
        1231 East Beltline NE
        Grand Rapids, MI   49525

Payment Options
You may have your premium automatically deducted from your checking or savings account or Social Security check. Learn more about payment options.

When Coverage Begins
Your coverage will begin the first of the next month and continue until you cancel it. You may only change or cancel your coverage at certain times; see the Evidence of Coverage booklet listed under each plan for complete details, or contact us.

H2320_4000_4006_59 F&U (01/07) S5857_4000_4006_59 F&U (01/07)
Last modified 01/30/07