Welcome to P4HB®

Some changes to an existing account can be made by calling 1-877-744-2101 or from this web site under MY ACCOUNT.

The online application should take about 10 minutes to complete. Once you have entered your information you will be asked to print an Income Verification form to complete your application process. Once you complete the forms you will be asked to fax or mail the forms and requested documents to the address provided.

Before you start, you may want to gather the following information to help you complete the application:
  • Information on any current or recent health insurance coverage.
  • Any household income from employment, child support and any other income.
You will have a chance to review all of the information you entered and make any changes or corrections before submitting the application.

If you would prefer not to complete an online application you may download a paper copy.

Download English Application        Download Spanish Application

If you need additional assistance, please call 1-877-744-2101.
en Español |P4HB Version 2.20.0 | 1-877-P4HB101 (744-2101)
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