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Member Update Form

Do you need to make changes to your personal information?

Elderplan can help while ensuring your privacy.

Make changes or written requests in four easy steps:

  • Download this document to update the following information:
    Member Information Update FormEnglish | Español
    (requires Adobe Reader, free from Adobe Systems):
    • Change of address
    • Change Primary Care Physician (PCP)
  • Get a new Elderplan member card (Reminder: While you DO NOT use your Medicare card for medical services, be sure to keep it in a safe place)
  • Print the form on your computer’s printer
  • Fill in the form completely, including your Elderplan Member ID number
  • Mail or fax your form to the following address:
    Elderplan Member Service

    55 Water Street 46th Floor, Suite 202
    New York, NY 10041
    Fax: 718-630-2624

If you have any questions about changes you make to your personal information or any written requests, please don’t hesitate to contact Elderplan’s Member Services Department.

Elderplan Member Service
55 Water Street 46th Floor, Suite 202
New York, NY 10041
Fax: 718-630-2624

If you have any questions about changes you make to your personal information or any written requests, please don’t hesitate to contact Elderplan’s Member Services Department.

Looking for information?

Questions? Call Elderplan today.

1-800-353-3765


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Hours of Operation:
8 a.m. to 8 p.m., 7 days a week

Elderplan is available in the Bronx, Dutchess, Kings, Monroe, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Westchester, Ontario, Orleans, Seneca, Yates, and Livingston counties.