NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE
For Pennsylvania, Oklahoma, Florida, Louisiana, Arkansas and South Carolina, if you intend to lapse or otherwise terminate existing accident and sickness insurance and replace it with a policy to be issued by TruAssure Insurance Company, then you will need to complete the following Replacement forms and return them to TruAssure Insurance Company.
Pennsylvania Documents
- Application for Max Savings, Choice and Choice Plus Plans
- Notice to Applicant Regarding Replacement of Accident and Sickness Insurance for Max Savings, Choice, and Choice Plus Plans NOTE: PLEASE SIGN ONE AND RETURN, AND SAVE THIS COPY FOR YOUR FILES
Consumer Direct – Individual
Box 804307
Chicago, IL 60680-4104
Oklahoma Documents
- Application for Max Savings, Choice and Choice Plus Plans
- Application for Basic and Preferred Plans
- Notice to Applicant Regarding Replacement of Accident and Sickness Insurance for Max Savings, Choice, Choice Plus, Basic and Preferred Plans NOTE: PLEASE SIGN ONE AND RETURN, AND SAVE THIS COPY FOR YOUR FILES
Consumer Direct – Individual
Box 804307
Chicago, IL 60680-4104
Florida Documents
- Application for Max Savings, Choice and Choice Plus Plans
- Application for Basic and Preferred Plans
- Notice to Applicant Regarding Replacement of Accident and Sickness Insurance for Max Savings, Choice, Choice Plus, Basic and Preferred Plans NOTE: PLEASE SIGN ONE AND RETURN, AND SAVE THIS COPY FOR YOUR FILES
Consumer Direct – Individual
Box 804307
Chicago, IL 60680-4104
Louisiana Documents
- Application for Max Savings, Choice and Choice Plus Plans
- Application for Basic and Preferred Plans
- Notice to Applicant Regarding Replacement of Accident and Sickness Insurance for Max Savings, Choice, Choice Plus, Basic and Preferred Plans NOTE: PLEASE SIGN ONE AND RETURN, AND SAVE THIS COPY FOR YOUR FILES
Consumer Direct – Individual
Box 804307
Chicago, IL 60680-4104
Arkansas Documents
- Application for Basic and Preferred Plans
- Notice to Applicant Regarding Replacement of Accident and Sickness Insurance for Basic and Preferred Plans NOTE: PLEASE SIGN ONE AND RETURN, AND SAVE THIS COPY FOR YOUR FILES
Consumer Direct – Individual
Box 804307
Chicago, IL 60680-4104
South Carolina Documents
- Application for Max Savings, Choice and Choice Plus Plans
- Notice to Applicant Regarding Replacement of Accident and Sickness Insurance for Max Savings, Choice, Choice Plus Plans NOTE: PLEASE SIGN ONE AND RETURN, AND SAVE THIS COPY FOR YOUR FILES
Please note: TruAssure cannot accept applications for individual insurance plans via fax or email. All applications must be mailed to TruAssure at the following address:
Consumer Direct – Individual
Box 804307
Chicago, IL 60680-4104
Plan Information and Rates