Request a New Health Plan Profile

Only one person from a health insurance company needs to submit this form to request a health plan profile:

• If the request is approved, the person submitting this form will receive an email with information on how to create their personal account.
• After creating a personal account, they can request to add new team members to the health plan profile.

If you want to submit a PSHB application for more than one health plan, submit this form for each health plan. For example, if you want to submit a PSHB application for Health Plan A and Health Plan B, submit this form twice – once for Health Plan A and once for Health Plan B.

Required fields are marked with an asterisk (*)