Member Advisory Group RSVP

Member First Name *

Member Last Name *

Phone Number *

Email Address

Year of Birth * (Example: XXXX)

Do you prefer text reminders? * Yes No

Do you need any special accommodations? * Yes No

The Contact Us form will send your message to Superior HealthPlan as an email. The email is not encrypted and is not transmitted in a secured format. By communicating with Superior HealthPlan through email, you accept the risks associated thereof. Superior HealthPlan does not accept responsibility or liability for any loss or damage arising from the use of email. To ensure the safety of your protected health information (PHI), please send us a message through the Secure Member Portal or call us to speak directly to a customer service representative.