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1. Download and print enrollment application
Enrollment Application (English)
Enrollment Application (Spanish)
2. Complete, sign and date the enrollment application
Remember to:
Select your Primary Care Physician
Select your Benefits (High or Low Option)
Select Plan Supplements as available
3. Select monthly payment option
Choose your method of payment and download appropriate form, fill out, sign and submit with your application.
Debit Card Authorization Form
Credit Card Authorization Form
Electronic Funds Transfer Form
(must include a seperate "voided" check.)
For Monthly Direct Billing, no form needed. Please check appropriate box on Enrollment Application
4. Mail your Enrollment Application, First month's premium deposit and Monthly payment option form to:
Care Access Health Plan
Underwriting Department
P.O. Box 4276
Hallandale, Florida 33008-4276.
Within a short time of submitting your completed Enrollment Application and first month's premium deposit, Care Access will review your information. If additional information or testing is required, we will contact you. Please reply promptly to any requests for more information, since the need for additional information may lengthen the enrollment process.
Care Access will determine if your application meets its medical underwriting guidelines and you will be notified as to whether your membership application has been accepted or declined. |
| If your application has been accepted, you will be enrolled and will receive your: Member Identification ID Card, Individual Member Contract and Handbook with Summary of Benefits, Effective Date of Coverage and Provider Directory. |
| If your application for membership is declined, you will be notified in writing at the address that you provided on the Enrollment Application and your deposit of your first month's premium will be returned to you. |
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Monday - Friday
Monday - Friday