Replace ID Card

Please complete this form to request a new Simplicity Health Plans Member ID Card for you and/or your dependents. You must complete all required fields of information in order to receive a new card. Please allow two weeks for delivery. If you need services before your card arrives, your Provider may call Simplicity Health Plans to verify your Membership. Please note, if you have changed your address since enrollment, you must first change your address in the Member section before applying for a new ID card. Replacement cards are sent to the confirmed address of record.

You must be signed-in to the Member section to use this form!

A separate form must be completed and submitted for each application/dependent.


If your Member and/or Dependent ID card was lost or stolen, or if the information on the card is a result of your own error, an administrative charge of $15 per card will be deducted automatically from your HSA. I hereby authorize Simplicity Health Plans to withdraw $15 from my HSA to replace my Member ID Card because my or my dependent’s card was lost or stolen, or the information I originally provided was in error. If Simplicity Health Plans has caused the ID card(s) to be replaced, there will be no charge to replace your card.