Please download and fill out all documents (that apply) to enroll in US Family Health Plan. These files are in the Adobe Acrobat PDF format. If you are not sure how to download these documents to your computer, please View these Instructions.
- Choose your Primary Care location first!
- Need help? Directions for Enrollment Application
- ENROLLMENT APPLICATION FORM
PLEASE NOTE - Only the Application form allows you to type directly onto the form before printing. All other forms (below) must be printed first and then hand written.
- TRICARE Young Adult Application Form
- Automatic Payment Form
(Complete to have payment automatically deducted from credit card or checking account.)
Please Mail or Fax the above forms to:Mail:
Johns Hopkins US Family Health Plan
P.O. Box 815
Glen Burnie, MD 21060-0815______________________________Fax: