Forms

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)

2009 MCHA Residency Verification Form (residence.pdf)

MCHA Change to a Standard (Non-Tobacco) Premium Rate - Request Form (chgtostd.pdf)

Authorization to Disclose Protected Health Information to a Designated Representative Form (phi.pdf)

Request for Copy of Protected Health Information Form (copyphi.pdf)
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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
For Medicare Supplement plan options call 1.800.325.3540
Hearing Impaired Call the National Relay Center at
1.800.855.2880 and Ask for the Appropriate Number Above