CalViva Health - Member Portal

REGISTRATION I already have an account

Step 1 of 3

Member Information

Member ID Number*

Member ID Number is same as CIN# in this field

First Name*

Last Name*

Date of Birth (MM/DD/YYYY)*

Name FIRST MI LASTNAME

CIN # XXXXXXXXX

Physician Group and PCP

PPG Name

PCP of Clinic Name

Street Address

City State Zip + 4

PCP PHONE:X-XXX-XXX-XXXX

Effective date with PCP: MM/DD/YY

Office Copay: $0

Issue Date MM/DD/YY

Enrollment Date MM/DD/YY

CalViva Health only covers medical and hospital services provided or authorized by your Participating Physician Group (PPG).

To change your PPG or Primary Care Provider (PCP), call CalViva Health Member Services at

1-888-893-1569 / TTY: 711 or visit www.calvivahealth.org

Rx BIN 022659 RxPCN 6334225

*First and last name must match ID Card.

REGISTRATION I already have an account

Step 2 of 3

Demographic Information

Phone

Email Address*

By providing your email ID you are allowing CalViva Health to communicate regarding your Health Plan information.

User ID*

User ID same as Email address

New Password*

Confirm Password*

Minimum of 8 characters & maximum of 30 characters
At least 1 letter in uppercase (A-Z)
At least 1 letter in lowercase (a-z)
At least 1 number (0-9)
At least 1 special character (- , $ , # , & , _ ,%)

REGISTRATION I already have an account

Step 3 of 3