Notice: We are aware of a nationwide cyber security incident impacting Change HealthCare. This does not impact your coverage but may cause delays in claims processing. Change Healthcare, which is owned by UnitedHealth Group, reported on April 23, 2024, that patient/member data may have been compromised, however, the extent of the data breach is not yet known. UnitedHealth has set up a website and toll-free number for members to call for more information. Please visit changecybersupport.com or call 1-866-262-5342 for more information and details on resources available. We continue to closely monitor the situation and will communicate updates as they become available. Our PHP portals are not impacted by this incident.

Life360 Enrollment Form

Fields that are marked with a red arrow are required in order to process your information.
  

MEMBER INFORMATION

*
Member Name:
*
Member PHP Number:
*
Member Address:
*
City:
*
State:
*
Zip Code:

Format: xxxxxx
Member Telephone Number:

Format: (xxx) xxx-xxxx
*
PROGRAM ENROLLMENT:

If enrolling into the Healthy Mom, Healthy Baby Program answer the following

Prenatal Care Physician:
When are you due to deliver?:
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Open the calendar popup.
For more information or for help with this form, please call Life360 Management Programs at 517.364.8466.

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1301 N. Hagadorn Rd., Suite 1E
East Lansing, MI 48823
517.364.8400 or 800.562.6197

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Physicians Health Plan (PHP) is NCQA Accredited for its Commercial HMO/POS combined product and Health Insurance Marketplace product.
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1400 East Michigan Avenue
Lansing, MI 48912
517.364.8400 or 800.562.6197

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Physicians Health Plan (PHP) is URAC Accredited for its HMO, Plus and Health Insurance Marketplace products. CAQH Core Seal