Application Submission Guidelines HealthAmerica One. New business submission and application completion guidelines. Forms that are needed with every paper application submission:. Required: APPLICATION TRUST AGREEMENT Suggested: MRS FORM (applicants under age 2 or over age 50)
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New business submission and application completion guidelines
AUTO ENROLLMENT PROCESS
1-866-347-2380, email CHCHAPA1Indv@cvty.com or by mail; Attention: Individual Medical Underwriting Dept P.O. Box 67103 Harrisburg, PA 17106-7103
Nancy Dudek, Account Executive (WPA & OH) firstname.lastname@example.org
412-577-5409 / 412-849-9150 / 800-735-2202 ext 5409