Make Enrollment Changes

It’s vital to manage your account to ensure the accuracy of our administrative records.

Add Employee or Dependent

To add a dependent or an employee to your plan:

• Complete the Employee/Dependent Change Form.
• Complete the Member Health History form for all newly enrolling employees and eligible dependents.
• All enrolling employees must complete and submit the Employee Checklist.
• Return to HCG the completed form above, two months premium for the enrolling member, and proof of employment for a newly-enrolling employee.

Group Changes

Any changes to your group should be updated so we can accurately maintain our records. Group changes* can be submitted with the following form:

• Group Enrollment/Change Form

* If you have made legal changes to your business such as a new tax ID number, the name of your business or a change in your business status, proof must be provided.

Terminations

Group, employee or member terminations can be managed with the Termination form below. Please note that terminations will only be processed outside of open enrollment when a qualifying event has occurred.

• Termination Form

Automatic Payments

To enroll in Automatic Payment withdrawal so that your monthly group premium can be deducted automatically from your designated business account, use the following form:

• ACH Form

If you have any questions or need any additional information at any time, please contact HCG at hcg@hcgaz.com.

All necessary forms should be completed, signed and submitted to:

Healthcare Group of Arizona
Attn: Enrollment Department
701 E. Jefferson St.
MD 1400
Phoenix, AZ 85034

Fax: 602.417.6798
E-mail: hcg@hcgaz.com