Virginia Premier Health Plan, Inc.

Member Forms

Change of Address form
Print this form, fill it out and send it to us to change your address.

Permission to Speak To form
This form is used to confirm the direction of an individual that Virginia Premier Health Plan, Inc. may use or disclose protected health information for a particular purpose.

Request ID Card form
Print this form, fill it out and send it to us to request a new ID card.

Request PCP Change form
Print this form, fill it out and send it to us to change your primary care physician.

How to submit these forms

To submit these forms to use, please print them from this web site, complete them and mail them to the following address:

Virginia Premier Health Plan, Inc.
ATTN: Member Operations
600 E. Broad Street
Suite 400
Richmond, VA 23220-0307

if you have additional questions, please contact Member Services.

How to read PDF files

In order to download and view PDF files, you should download the free Adobe Acrobat Reader and install it on your computer.