ATTENTION: As New York reopens, so are we! Starting in May, select Community Service Centers (CSCs) in the Bronx and Westchester County will welcome back in-person visits. Check which CSCs are opening and which will remain closed. To speak with a representative live via Zoom, visit AffinityPlan.org/Live or call 866.247.5678.
  • Primary Care Physician Change Request

  • Member Information

     

    Current PCP Information

     

    New PCP Information

     
     

     
    I hereby authorize Affinity Health Plan to make the changes indicated above.
    Only one change request per form please. If you have additional requests, please complete separate forms.
    Please allow up to 5 business days for us to process this form.
    Note: PCP change requests will be retroactive to the 1st of the month that the request was received by Affinity only if the member has active coverage.