• Enroll Now
• Enrollment Instructions

Call: 1-800-892-3351.
TTY/TDD should call
1-800-216-1307.
Hours of operation are: 8 a.m. to 8 p.m. local time, Monday through Friday.

Enrollment Instructions

There are several ways to enroll in a HealthMarkets Care Assured^SM plan.

• You can request an application online.
• You can call us at 1-800-892-3351 (TTY/TDD: 1-800-216-1307) hours of operation are: 8 a.m. to 8 p.m. local time, 7 days a week through 3/31/08, or
• You can apply online.

For online applications, please supply all of the information requested so we can process your enrollment as quickly as possible.

1. Plan Selection — Indicate the Care Assured Plan in which you have chosen to enroll.
2. Personal Information — Name, address, social security number, etc.
3. Medicare Information — Fill in the blanks directly from your Medicare card or you can make a copy of your card and attach it to the enrollment form.
4. Plan Premium Option — Indicate how you prefer to be billed each month. Be sure to print out and complete the Optional Automatic Monthly Payment Agreement as well as your voided check or deposit slip, if you are choosing this option.
5. Provider Contact Information — Complete the contact information for your preferred providers.
6. Important Questions — Read and answer all questions.
7. Stop Sign — Be sure to read the statement underneath Stop Sign.
8. Statements of Understanding — Read all of the additional statements of understanding.
9. Signature and Date — By clicking on the “I agree” button, you are supplying your electronic signature and agreeing to the terms and conditions of the plan. You must complete a separate application for each person enrolling. If an authorized representative is signing for you, have that person complete the appropriate section.
10. Go back and review all sections to make sure they are complete. Missing information will result in delays in processing your enrollment request.
11. Mail the completed form to:
    

    HealthMarkets Care Assured Plan
    The Chesapeake Life Insurance Company
    PO Box 37653
    Philadelphia, PA 19101-0653

Print Optional Automatic Monthly Payment Agreement

HealthMarkets Care Assured^SM (“Care Assured” or the “Plan”) is a Medicare Advantage Private Fee-For-Service Plan (PFFS), under a contract with the Centers for Medicare and Medicaid Services (CMS). Our contract with Medicare is renewed annually and availability of coverage beyond the current contract year is not guaranteed. A Medicare Advantage PFFS plan works differently than a Medicare supplement plan. Your doctor or hospital is not required to agree to accept the plan’s terms and conditions, and thus may choose not to treat you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may choose not to provide health care services to you, except in emergencies. Providers can download the plan’s Terms and Conditions.