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2026 NV Enrollment Form (Simplified Chinese)

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2026 NV Enrollment Form (Vietnamese)

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2026 NV Enrollment Form (Spanish)

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2026 NV Enrollment Form (English)

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2026 CA Enrollment Form / (Simplified Chinese)

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2026 CA Enrollment Form (Vietnamese)

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2026 CA Enrollment Form (Spanish)

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2026 CA Enrollment Form (English)

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2027 Bridge Case Management Form (Vietnamese)

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2027 Bridge Case Management Form (Spanish)

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2027 Bridge Case Management Form (English)

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New Member Enrollment for Agents

For Agents Only. Use our Connecture online enrollment application to enroll a client in minutes — no paper forms required.
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Agent Portal

For Agents Only. Login to the Agent Portal.
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Provider Portal Login

To register for portal access: Select the Champion Health Plan Select First Time User Complete Login Form *Please request user access using the URL.
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2027 Agent Manual

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2027 NV Enrollment Form (Vietnamese)

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2027 NV Enrollment Form (Spanish)

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2027 NV Enrollment Form (English)

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2027 CA Enrollment Form (Traditional Chinese)

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  • Plan Documents

2027 CA Enrollment Form (Vietnamese)

  • Document