McLaren Health Plan Customer Service Contact Request

Note: Fields marked with an * indicates required field

Enter First Name: *

Enter Last Name: *

Enter Date of Birth (xx/xx/xx): *

Enter Address: *

Enter City, State, Zip: *

Enter Type of Health Insurance: *
Medicaid
Commercial

Enter Employer Name:

Member identification Number (found on Card) or
Social Security Number if Member ID is unknown:

Enter Email Address:

Enter Phone:

For PCP changes, please provide the new physician name: *

For PCP changes, please provide the new physician address: *

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