Register as an authorized personal representative for the Mass General Brigham Health Plan Member Portal

An authorized personal representative is person who is designated to act on behalf of a member. To appoint an authorized personal representative, complete the form for your plan below and submit a signed copy to Mass General Brigham Heath plan.

Only authorized personal representatives whose forms have been submitted and approved will be able to register for the member portal.

• If you are on a Medicare Advantage, Medicaid, or ACO/MassHealth plan, use this form: view the form.
• For all other plans, please use this form: view the form.

Tell us about the member you are registering for

Member ID

The Member ID number can be found on the member ID card below the name.

Last Name

Zip Code

Date of Birth

Tell us about yourself

Your First Name

Your Last Name

Relationship to member

Choose... Executor of estate Parent Provider Power of attorney Relative, friend, other guardian

Your Address

Your Address (line 2)

Your City

Your State

Your Zip Code

Your Email Address

Email Confirmation

Your Phone Number

Phone Number Type

Land Line

Mobile

Choose your account information

Username

Your login must be between 4 and 64 characters long. You can choose your own login using letters, numbers, and the following characters .-_ Or you can use your email address

Password

Password must: Be between 8 and 32 characters long. Be unique from your username. Contain at least one lower case letter, one upper case letter, and one number.

Confirm Password