For Subscribers

To ensure Eligibility Guidelines, brochures, applications and rates reflect legislative requirements of the CHAND program, they are no longer available in paper form. Please refer to the links below.

If you need additional information regarding CHAND, please contact us.

Brochures

Traditional Brochure
HIPAA Brochure
TAARA Brochure
Standard Supplement Brochure
Basic Supplement Brochure

Forms

Please note if you are a Traditional applicant, you must review the Creditable Coverage Disclosure Notice.

Traditional Application
HIPAA Application
TAARA Application
Supplement Application
Creditable Coverage Disclosure Notice

Authorized Representative Form
Please complete an Authorized Representative Form and include it with your application.

Authorization to Release Information Form
Authorize release of your information to a person or organization.

Automatic Payment Withdrawal
Authorize your financial institution to deduct CHAND premiums from your account.