Health Advocate

Member Form About Health Advocate

In order that we may best serve you, please include the following information.   We will respond by the next business day.
*Full Name:
*Employer who offers your
  Health Advocate benefit:
*Email:
*Confirm Email:
*Home Phone:
Work Phone:
Cell Phone:
The information requested below is optional but may assist us in helping you more quickly. 

You may want to look at your insurance card to fill in the boxes.  If you do not know which plan you have, please leave these fields blank.
Name of Insurance Carrier (e.g. Aetna)
Name of Plan (e.g., Aetna Open Access)
ID Number (please refer to your health insurance card): 
Is this for you or a family member?
If you are filling out this form for someone other than yourself, kindly provide her or his name:
Would you like us to communicate with you or your family member via phone or email?
I need assistance with
In the box below, please describe the issue for which you need assistance.
(limit to 250 characters)
We may contact you to obtain additional information.

*Indicates required information.
 

  Live Help