Easy Choice Health Plan (HMO)

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Member Resources

Enrollment Applications

Member Enrollment Applications

Thank you for your interest in Easy Choice Health Plan (HMO) where we’ve got just one goal: To make healthcare Easy for you. If you are interested in enrolling into Easy Choice Health Plan (HMO), and do not wish to make an appointment with one of our sales representatives, you may download the attached enrollment forms and mail them to the location listed below. By accessing these links, you acknowledge that you have reviewed the Easy Choice Health Plan (HMO) Summary of Benefits, Evidence of Coverage , Pharmacy Formulary , and the Provider Search Function which are all materials provided within this website.

Mailing Address:

Attention: Enrollment Department

P.O. Box 22653

Long Beach, Ca 90801-5653

2013 Applications:

Armenian - Enrollment Application Form (Download PDF)

Cambodian - Enrollment Application Form (Download PDF)

Chinese - Enrollment Application Form (Download PDF)

English - Enrollment Application Form (Download PDF)

Farsi - Enrollment Application Form (Download PDF)

Korean - Enrollment Application Form (Download PDF)

Russian - Enrollment Application Form (Download PDF)