Copay 4500 — Enrollment Application

PHCS / Multiplan Network

Step 1 of 6CoverageApplicantQuestionsPaymentBrokerReview

Read what the plan covers before you start.Summary of Benefits and Coverage (PDF)

Your selectionPick your coverage tier below to see your monthly price and effective date.

Coverage

List Bill Group ID (only if your company set one up — 6 or 7 digits)

Coverage effective date *

Questions about this application?

Fage Financial Services