If you qualify, completing the Health Plan Choice Form is easy! Follow the three simple steps to begin your enrollment into the Anthem Blue Cross Cal MediConnect Plan. You can also get free help with this form by calling Health Care Options at 1-844-580-7272 (TTY: 1-800-430-7077) Monday through Friday from 8 a.m. to 6 p.m.
The Los Angeles County Health Plan Choice Form is the document you will need to submit. The examples below will help show you how to fill out the form.
Add your personal information:
Select Anthem from Option A:
Sign and date the form:
Mail the completed form to:
California Department of Health Care Services
Health Care Options
P.O. Box 989009
West Sacramento, CA 95798-9850
If you have questions about mailing your form, or would like a free addressed and stamped envelope, please contact Member Services toll free at 1‑888‑350‑3447 (TTY: 711), Monday through Friday from 8 a.m. to 8 p.m. for more information.
Health Care Options Website: https://www.healthcareoptions.dhcs.ca.gov/
Health Care Options Phone Number: 1-844-580-7272 (TTY: 1-800-430-7077) Monday through Friday from 8 a.m. to 6 p.m.
You can also call Member Services at 1-888-350-3447 (TTY: 711) Monday through Friday from 8 a.m. to 8 p.m. for more information. This call is free.