Forms

Enrollee Authorization to Release Information (release.pdf)

MCHA Cancellation Form (cancel.pdf)

Automatic Premium Payment Option (appo.pdf)

MCHA Plan Change Request Form (pcr.pdf)

Enrollee Address Change and Dependent Additions Form (eacda.pdf)

2008 MCHA Residency Verification Form
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Minnesota Comprehensive Health Association
Customer Service, Mail Route CP555
401 Carlson Parkway
Minnetonka, MN  55305-5387

For deductible plan options call 1.866.894.8053
or our TTY line at 1.800.841.6753
For Medicare Supplement plan options call 1.800.325.3540
or our TTY line at 1.800.234.8819