Plexus Health Solutions, Inc. - Full Service Medical Billing

Medical Billing Services

Change of Insurance Form

To change your name or update address information please use the Change of Name Form or Change of Address Form on this site.


Name of your Doctor:
Name of New Insurance Company:
Mail Claims To:
Subscriber's Name:
Subscriber's Employer:
Subscriber's Date of Birth:
Policy or ID Number:
Group Number:
Effective date of this policy:
Names of family members covered under this policy:
Is this coverage Primary or secondary?
What is the name of the insurance carrier being replaced with this policy?