• Primary Care Physician Change Request

  • Member Information

     

    Current PCP Information

     

    New PCP Information

     
     

     
    I hereby authorize Affinity Health Plan to make the changes indicated above.
    Only one change request per form please. If you have additional requests, please complete separate forms.
    Please allow up to 5 business days for us to process this form.
    Note: PCP change requests will be retroactive to the 1st of the month that the request was received by Affinity only if the member has active coverage.

Company Name Affinity Health Plan

 

The mission of Affinity Health Plan is to improve the health and well-being of its Members, their families, and their communities in collaboration with primary care providers.

Affinity strives to be the health plan of choice for its Members and its providers -- known for assuring access to high quality, cost-effective care; delivering the best customer experience; and contributing significantly to achieving a patient-centered health care system.

Contact Us

Affinity Health Plan
1776 Eastchester Road
Bronx, New York, 10461
Fax:718.794.7804
TTY/TDD users:711
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