How To Complete
Enrollment Form Process
There are 4 ways to Enroll/Apply for
Five Points Health Benefits Student Coverage
1 - Apply online. Visit this page and select your state to get started.
2 - Apply by phone. Call 915.803.4198 to apply for a health benefit plan and enroll over the phone.
3 - Apply in person. Visit a trained counselor in your community to get information, apply, and enroll in person.
4 - Apply by mail, email or fax. Complete your PDF printable application and mail it in, email it or fax it.
1 ONLINE STUDENT APPLICATION
Electronically fill out the application and then complete ALL enrollment information and plan options which apply.
Please complete LEGIBLY, in its entirety, each section of the document, signed and dated
2, 3 & 4 - PRINTABLE PDF STUDENT APPLICATION
STEP 3 - PRINT PDF STUDENT APPLICATION AND SUBMIT IN PERSON AT OUR OFFICE
Attention Student Enrollment Services
Five Points Health Benefit Plans, LLC
6006 North Mesa Street - Suite 108
El Paso, Texas 79912
STEP 4 - PRINT PDF STUDENT APPLICATION AND FAX, EMAIL OR MAIL
1. Print and send fax to (915) 519-0261 [SECURE LINE]
2. Upload file and email to: firstname.lastname@example.org
*Please be advised to keep a copy of these documents for your own records*
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)
2) Your ID member card from the First Health Network is a Aetna | Coventry Company
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
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
Telephone Number: 915.803.4198