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Community Health Group
Provider Login Member Login

Member Handbook (EOC)

Select your health plan to view the Member Handbook (EOC)

Medi-Cal

Public program for low income people

Select plan

CommuniCare Advantage

Medicare and Medi-Cal benefits

Select plan

Community y Más

Medicare plan for chronic care needs

Select plan

Marketing Referral

Community Health Group

Marketing Referral

Fill out the following form to express interest in joining Community Health Group
First Name*
 
Last Name*
 
Middle Initial
 
Medi-Cal ID
 
Birth Date
 
Phone #*
 
Email
 
Primary Language
Permanent Residence. Don't enter a P.O. Box unless you're experiencing homelessness*
 
City*
 
County
 
State*
 
Zip code*
 
Coverage Request
Which coverage are you interested in?
This Enrollment Request Form is for
Additional applicants
Name
 
DOB
 
SSN
 
Name
 
DOB
 
SSN
 
Name
 
DOB
 
SSN
 
Name
 
DOB
 
SSN
 
Name
 
DOB
 
SSN
 
Other Information
How did you hear about Community Health Group
CHG Representative
Optional
Marketing Representative Name
 
Health Plan Name
 
Acknowledgement
Please have a Community Health Group representative call me to set up an appointment.
Please Enter Electronic Signature*
 
Date*
 

Fill out the following form to express interest in joining Community Health Group

Complete all fields unless marked optional
* Required Field

10 digits phone number

2 letters state

5 digits zip code

Which coverage are you interested in?
This Enrollment Request Form is for:
Primary Language
How did you hear about Community Health Group
CHG Representative
Optional

Acknowledgement

Please have a Community Health Group representative call me to set up an appointment.