Member change form

Please complete the information related to your changes and "submit" this form. With this form you can:

  • Request an ID card
  • Change your PCP

Changes regarding: Medical coverage
Dental coverage
Medical and dental coverage

  Format: 00-00-0000

For authentication purposes, at least one field below is required*:

  Format: 111-111-1111

Request ID card?


Change PCP?

Steps to selecting a new PCP:
  1. View our directories to choose a new PCP on your plan's network.
  2. Contact your new PCP's office to ask if they will accept you as a patient; some offices do not accept new patients.
  3. Remember your new PCP is effective at the beginning of the next month.
  4. You may change your PCP up to two times every six months.

Established patient?


*Required fields

Email is not a secure method of transmission. If you prefer, you can reach us by telephone or mail. EOCCO will respond to your inquiry within 24 to 48 hours, excluding weekends and holidays.