How to Enroll
If you are eligible to enroll and have made your selection, please choose from the options below.
ENROLL ONLINE
Choose a plan below to complete your application online. (You will be able to print a copy of your completed application for your records.)
2012 Medicare Advantage Prescription Drug (MAPD) Plans
SummaCare Secure Core (HMO)
SummaCare Secure Silver (HMO-POS)
SummaCare Secure Gold (HMO-POS)
SummaCare Secure Platinum (HMO-POS)
2012 Medicare Advantage (MA) Plans
(Note: this plan does not include prescription drug coverage)
SummaCare Secure Classic (HMO-POS)
CALL US
Call us at 888-464-8440 and we can take your enrollment information over the phone. (TTY 800-750-0750)
MAIL US YOUR PAPERWORK
Please click on the Enrollment Application of your choice BELOW to print, complete and return to us by mail to:
SummaCare Secure
P.O. Box 3620
Akron, OH 44309-3620
You will receive a confirmation letter when we have received your enrollment form.
2012 Medicare Advantage Prescription Drug Plans (MAPD) Enrollment Form
For SummaCare Secure Core (HMO), Silver (HMO-POS), Gold (HMO-POS) or Platinum (HMO-POS) plans.
2012 Medicare Advantage (MA) Enrollment Form
For the SummaCare Secure Classic (HMO-POS) plan.
Helpful Hints:
- When enrolling in one of our MAPD or MA plans, please be sure to select a Primary Care Physician (PCP) and include their PCP number on the Enrollment Form.
- To have your monthly premium (if applicable) automatically deducted from your checking or savings account or charged to your VISA or MasterCard, please complete and return our Direct Debit/Credit Card Authorization Form.
- Medicare beneficiaries may also enroll in SummaCare Secure through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
Last Updated: 03/27/2012