*Complete and submit the application below for an Ohio Plan membership proposal.
Please note that current Ohio Plan members are provided annual updates of the attached application through their respective Regional Representative. Prospective Ohio Plan members may submit a completed application to Rebecca Swisher. The Regional Representative for your area will present the membership proposal at your convenience.
Questions and applications should be directed to:
Hylant
Administrative Services
Attn: Jason Chapman
P.O. Box 2083
Toledo, OH 43603-2083
Email:
jason.chapman
Phone: 800-248-5268
Fax: 419-259-6099
*A confirmation
notice will be sent within 2 business days upon receipt
of application.
