Member ID Card Request

Online Member ID Card Request Form

To request a CalOptima Member ID card, complete this Member ID Card request form. If you have any questions or need assistance, please contact our Customer Service department at 1-714-246-8500 or toll-free at 1-888-587-8088, Monday through Friday, from 8 a.m. to 5:30 p.m. We have staff who speak your language. TDD/TTY users can call 1-800-735-2929.

*=Required field

 


Member Information

 
 
( ) -  
 
 
/ /  
 
 
 
 


Requestor Information

 

 
 
( ) -  
 

Comments


Text Size