Care Access Health Plan

Toll Free: 877-411-CAHP (2247)
Email: info@mycareaccess.com

Broker Agent Data Form
Broker Agreement
W-9 Form

Individuals

Enrollment Application Process & Checklist
Individual Enrollment Application
Credit/Debit Card Transaction Authorization Form
Electronic Fund Transfer Form
Field Underwriting Guidelines

Group of Individuals

Group of Individual Application Checklist
Individual Enrollment Application
Supplemental Medical Questionnaire
Administrative Service Agreement
Field Underwriting Guidelines

Groups

Group Application Checklist
Group Employee Census Form
Quote Request Form
Group Application and Certification Form
Group Enrollment & Status Change Form
Field Underwriting Guidelines

© 2010 Care Access Health Plan, Inc. • Licensed by the Florida Office of Insurance Regulation • Privacy Policy • info@mycareaccess.com
P.O. Box 4276 • Hallandale, Florida 33008-4276 | Phone: (305) 614-5010 • Toll Free: 877-411-CAHP (2247) • Fax: (305) 614-5011