Enrollment tool unavailable
We're sorry, our enrollment tool is not working correctly and we're working on it. In the meantime, please use our PDF forms:
- Enrollment form
- Medicare group enrollment form
- Member change form
- FSA enrollment change form
- FSA enrollment change form - employer contribution
Send the completed enrollment/change form to the Enrollment department:
Email:
Fax:616.942.5242
Mail:Priority Health
MS 2275
1231 E. Beltline NE
Grand Rapids, MI 49525