Harvard Pilgrim Health Care Home

Member Home  |  About Us  |  Contact Us  |  Find a Doctor
Print    Text Size

Request for plan information

Thank you for your interest in Harvard Pilgrim Health Care. To view or print a copy of our product brochures, click on the product name. To receive a product brochure in the mail, please call 1-800-848-9995.

Employer Group Plans Individual Plans
Self-employed or groups of 5 or less  

If you would like to have a Harvard Pilgrim representative contact you, please complete the information below. (*required fields)

Your Name: *
Company Name:*
Zip code:*

I am a prospective member employed by an organization that offers Harvard Pilgrim Health Care
Total number of employees:
Total number of employees eligible for your health insurance benefits:
Renewal date of current plan (employer groups): (ex. 01/01/11)
I am eligible for Medicare
I would like to receive a quote from Harvard Pilgrim

By using this form to send your request to Harvard Pilgrim, you will be sending information over the Internet. Harvard Pilgrim uses 128-bit Secure Socket Layer (SSL) encryption in order to secure the information you send to us over the Internet. There may be times when we cannot respond to your request in email format and another method of communication will be used. For your privacy, please consider the content of your question, the location of your email account, and who, besides you, may have access to that account.