Simply print and complete the paper Enrollment Form found below and mail or fax the form to us at:

Fax: (602) 975-4071

You can also bring your completed Enrollment Form to any of our offices locations.

Please print the Enrollment Form that matches the county in which you reside. You must also complete and submit the Attestation of Eligibility Form along with your Enrollment Form. To view plan information including Summary of Benefits and Star Ratings, go to Plan Options.