Champion Health Request for Legal Resources & Acknowledgment

Our Legal Resources are provided exclusively to our authorized agents and representatives.

If you are a prospective client interested in learning more about the CHAMP Plan™, please contact your CHAMP agent or representative. If you are not currently working with an agent, we can help you. Please complete and submit the form on this page (select “Employer” from the dropdown box) and we’ll reach out to you quickly.

If you are a current member (employee) or group (employer) on the CHAMP Plan and need to contact us to learn more about our plan or change your coverage, please complete and submit the form on this page (select “Employee” or “Employer” from the dropdown box). You can also call our Customer Service team at 602.854.3522 

Document Requested
Note: Only one document allowed per request
Have you provided a full initial presentation to the party to whom the document will be provided?

Champion Health, Inc. (“CHI”) has prepared legal resources for the specific, limited purpose of analyzing the legal and compliance aspects of the CHAMP Plan. Such resources are and must remain confidential. CHI legal resources may not be distributed or shared for any marketing purposes.

The undersigned hereby acknowledges and agrees that the document requested above and any related passwords will only be used for the above-described purpose and will only be shared with the above-listed party.

In the event the undersigned wants to share the document and/or password for any other purpose and/or with any other party, the undersigned understands and acknowledges that the undersigned must prepare and execute a new request.

By submitting this request form, you attest that all information provided is accurate.

Your Name

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