Welcome to Health Plan of Nevada!
We will do our best to keep you healthy and give you quality medical
care. Please take a few minutes to fill out this form. We want to be able to contact you and to know about
your special health care needs. Your benefits will not be reduced because you answered these
If you need help filling out this form, call us at 1-800-962-8074
, TTY 711
between 8 a.m. and 5 p.m. Monday through
You may also choose to download a PDF version of the form to be filled out and mailed in.