Forms | 5 POINTS HEALTH

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Five Points Benefit Plans, LLC

Applications and Forms

We Can't Wait For You to Join!

Enrollment Forms

Employer Group Registration Form

Employers and Organizations Self-funded Group Plans - Enrollment Form

Individuals, Families & Self-Employed Association Plans - Enrollment Form

College Students - Enrollment Form

Credit Card Form (ACH)

ACH Payment Form

Cancellations

We are sorry to see you go. If you have questions or concerns that we can answer please feel free to call before you cancel: 1-800-785-1830

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