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Enroll by Fax
Click the button to the right to download Inter Valley Health Plan's Enrollment Form, complete the enrollment form, sign and date it, then fax it to Inter Valley Health Plan at:
(909) 397-0139

Click here for instructions on completing the enrollment form

Enroll by Mail
Click the button to the right to download Inter Valley Health Plan's Enrollment Form, complete the enrollment form, sign and date it, then return it to Inter Valley Health Plan at:
Sales Department
Inter Valley Health Plan
PO Box 6002
Pomona, CA 91769-6002
Please be sure to date the enrollment form

Click here for instructions on completing the enrollment form

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ABOUT US | MEDICARE PLANS | RESOURCES | MEMBER SERVICES
H0545_RAY2012_136V2 CMS Approved: 12/07/2011
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