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  • CHCC Employer Opt-In Form

    This form must be completed and signed before we can accept ChoiceCare or SelectCare enrollments from your employees. You can sign electronically below and press "submit" or print and fax to 866-402-4243 or print and mail to Apogee Members LLC, CHCC Health, P.O. Box 585, Rosemont, IL 60018 This form is not an application for insurance. Do not cancel any existing insurance programs until approved in writing. This form does not bind the signer to any financial liability for any products enrolled in by themselves or their employees unless informed of and agreed to in a separate application for coverage. (To sign use your mouse, or finger on touch screen device.)
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