SAM’S CLUB^TM Membership Application

Health Plan of Nevada’s Medicaid plan is proud to offer our members a one-year Sam’s Club membership.*

How to apply for a Sam’s Club membership:

Complete the entire form below to receive your e-gift card. Once your application is processed, you’ll receive an e-gift card by email. Take your e-gift card to the nearest Sam’s Club location to finish signing up for your membership.

First Name:

Last Name:

Birthdate:

HPN Member ID (11-digit number on the front of your health plan ID card):

Email Address:

Re-enter Email Address:

Primary Phone:

Street Address:

City:

State:

Zip Code:

Country:

All fields are required to process your application and receive an e-gift card. If you have any questions or need help filling out this form, please call Member Services toll-free at 1-800-962-8074, TTY 711.

*You must be an active member of Health Plan of Nevada’s Medicaid plan at the time the application is submitted to be eligible for this benefit. Only one membership per household. You must submit the form during the 2022 calendar year and no later than December 31, 2022. Please allow two to eight weeks after the form is submitted to receive your e-gift card.

SAM’S CLUB^TM Membership Application

How to apply for a Sam’s Club membership:

Helpful Links

Partners

SAM’S CLUBTM Membership Application

How to apply for a Sam’s Club membership:

Helpful Links

Partners

SAM’S CLUB^TM Membership Application