Sales Materials and Forms

Looking for an enrollment form or want to check out Care Choices service area? Select the material you are looking. If you can't find what you need, please call the Business Support Call Center at (800) 261-3452 for assistance.

The following forms must be downloaded, printed, and completed. They cannot be filled out online or submitted online.

Participating Hospitals	Other Forms
Enrollment & Change Forms	Quality Information

Care Choices HMO Participating Hospitals

Preferred Choices PPO Participating Hospitals

[Top]

Enrollment material checklist
Make sure you have everything for a complete enrollment application.

2-50 Eligibles - New Small Group Checklist

2-50 Eligibles - Renewal Small Group Checklist 

51+ Eligibles

Employer Group Application (GOA) Worksheet
Required for each new group.

Employee Waiver Form

Enrollment Application/Change Form and Waiver of Residence Requirement
Enrolling a new employee or have an employee-status change? Or do you have employees who live outside of the Care Choices service area?

Member/Contract Termination Form

[Top]

HIPAA Authorization Form   OR   en Español

Prescription Drug Claim Form

[Top]

Quality Report
See how our members rated Care Choices

[Top]