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You can apply for our plans in one of the following ways:
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Option 1. Apply Online Now.
Submit your entire application online with no paperwork.
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Option 2. Download & Print Application Now.
You can download the application, print it out, and mail or fax it to our office.
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Use this form to apply for Adult, HDHP and Kids plans as well as Prescription Drug Rider and Supplemental Maternity Coverage.
Carolina Care Plan
InsureOne Benefits
P.O. Box 239
Litchfield, Ohio 44253
Toll free: 877/271-4095
Fax: 330/721-8815 |
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Option 3. Request An Application.
We can send you an application by mail, email, or by fax. Just fill out the form below. |
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Option 4. Would you rather talk to us?
Just call us at 877/271-4095 and we'll help you apply step-by-step. |
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Additional instructions: |
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Call 877/271-4095 if you need help or to learn more. |
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Once you have downloaded and printed out the form write clearly using a blue or black ballpoint pen. |
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After carefully reading each section and answering all questions, be sure to sign and date the application. All applications will be considered invalid 60 days after the signature date. |
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What happens next: |
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Once your application is received, it will be reviewed to ensure that all information is accurate and all questions completed. |
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Your application will be sent to Carolina Care Plan's Underwriting department for further review. |
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Within five to seven days, we will notify you of your acceptance (including your actual monthly premium), or inform you if you have been denied coverage. At that time, if you accept the approved premium rates, an invoice for the first month of premium will be mailed to you. |
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Do not cancel any current health coverage until you receive an approval letter and policy documention, also known as a contract or certificate, from Carolina Care Plan. Make sure you understand and agree with the term of the policy. Pay special attention to the effective date, premium amount, benefits, limitations, exclusions, and riders.
The rates quoted are estimates only, and are subject to change based on your medical history, the underwriting practices of Carolina Direct, the optional benefits you selected, if any, and other relevant factors. Carolina Direct reserves the right to change the terms of the policy under proper notification. |
