1. Adaptive Form Title
  3. First Name
  4. Last Name
  5. ZIP Code
  6. Phone Number
  7. When is the best time to call?
  8. Email
  9. Reason for Inquiry
  10. How did you hear about Select Health?
  11. Comments
  12. CAPTCHA
  13. Submit Request
  14. By sharing your phone number, you’re giving permission for a Select Health sales representative and/or appointed agent to contact you by phone to provide information about Select Health Individual plans. Your consent is voluntary and allows Select Health to contact you via text messaging or email for marketing purposes. You may change your preferences at any time and doing so will not affect your eligibility for Select Health benefits and enrollment, coverage, or ability to get treatment. Data use charges and rates from your cellular carrier may apply. Your information will not be used for other advertising.

Request Plan Information Form

Please fill out this form to request information from a Select Health sales team member.

You can also call us anytime: 855-442-0220.

 

By sharing your phone number, you’re giving permission for a Select Health sales representative and/or appointed agent to contact you by phone to provide information about Select Health Individual plans. Your consent is voluntary and allows Select Health to contact you via text messaging or email for marketing purposes. You may change your preferences at any time and doing so will not affect your eligibility for Select Health benefits and enrollment, coverage, or ability to get treatment. Data use charges and rates from your cellular carrier may apply. Your information will not be used for other advertising.

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Fair Treatment Notice & Language Access Services