• Members
• Authorized Representative

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.

Authorized Representative

To authorize a designated representative to sign for you, print out and complete the Authorized Representative form below. Send the completed form along with the required documentation to:

HealthMarkets Care Assured Plan
The Chesapeake Life Insurance Company
PO Box 37675
Philadelphia, PA 19101-0675

ATTENTION: MEMBER SERVICES

Authorized Representative Form