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How To Complete
Enrollment Form Process
College Students
As a second option, you may submit your paper enrollment and payment through our secure email or secure fax.
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1 - Open your Student Paper Enrollment Application and ACH Payment Form by clicking on the Student Paper Enrollment Application and ACH Payment Form above.
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2 - Fill out your Student Paper Enrollment Application and ACH Payment Form. Make sure you fill out all of the required fields.
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3 - Please save your completed enrollment application and completed ACH Payment Form as a new file with your first and last name. (Example, Student Enrollment Form John Smith).
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3a - Once completed, please attach your completed enrollment application and your ACH Payment Form and email it to the following POC: Alejandra@fivepointsmecplan.com
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4 - Alternatively, you may fax your completed enrollment application and completed ACH Payment Form to the following fax number: 915.519.0261
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5 - You may mail your completed enrollment application and completed ACH Payment Form to the following address:
Five Points Health Benefit Plans, LLC
6006 North Mesa Street - Suite 108
El Paso, Texas 79912
We have created a video to help you easily enroll for your mobile phones or tablet.
Once your application is completed and received, we will then mail out to you your welcome packet which will include the following:
Once enrolled and your payment is processed, you will receive your Enrollment Packet in the US mail within 5 Business days:
1) Welcome Packet which includes your welcome letter with your Summary of Benefits (SOB). You will also receive a temporary Member ID Card and OptumRx Card which can be used right away.
2) Your ID member card from the First Health Network is a Aetna | Coventry Company
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First Health Network is a Aetna | Coventry Company, You will need to take your ID Network Card to your doctor appointments as proof of coverage.
3) Optum Rx ID Card
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You will need your Optum Rx ID Card when you pick up your prescriptions from any of the major pharmacies.
Customer Service Center hours: M-F, 7am - 5pm
Office Telephone Number: 915.803.4198
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