H7731_Enrollment Form CMS Approved (09/30/2010)
H7731_2011_Enrollment Form Spanish CMS Approved (09/30/2010)
MD Care Healthplan
Attn: Enrollment Department
P.O. Box 92919
Long Beach, CA 90809
The application is in Adobe PDF Format. You will need to download the Adobe Acrobat Reader here if you do not already have it.
Within 7 calendar days of the receipt of your paper enrollment request, MD Care will provide you with either a written notice that acknowledges receipt of your completed enrollment request, or if your application is incomplete MD Care will send you a written request asking for additional information to complete your enrollment or denial of enrollment.
This information is available for free in other languages. Please contact our Customer Care number at 1-888-285-9676 for additional information. Esta información esta disponible en otros idiomas sin costo alguno. Por favor comunicarse al Departamento de Membrésia al 1-888-285-9676 si desea información addicional.
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