PacifiCare Apply

Before you apply, please view the PacifiCare brochure for Plan Provisions, Limitations & Exclusions, and State Variation information:

PPO - 25/80-60/1000

PPO - 35/80-50/1000

How To Apply

Apply Online:  The quickest and easiest way to apply is to use Pacificare’s secure online application.  The information is transmitted directly to the underwriting department, and we are also notified.  We will keep you informed of the status of your application, and let you know as soon as you are approved.

Apply by mail or fax:  You may also fax or mail in an application.  Simply open the Pacificare Application , and print a copy.  Follow the instructions and fax the application to us at 866-284-0082, or mail it to the address below. (If you are unable to print an application, email us and we will send you one in the mail.)

Note:  All policies come with a money-back guarantee.  After receiving your policy, you have 10 days to review it.  If for any reason you decide not to keep the policy, you will receive a full refund of your initial premium.