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Enrollment Kits

For enrollment kits for The Health Plan/THP Insurance Co. SecureCare (HMO), SecureCare SNP (HMO SNP), SecureChoice (PPO), SecureCare (HMO) Capitol Plan, SecureChoice (PPO) Capitol Plan, or THP Medicare Supplement Plan programs, please complete the following form, select the enrollment kit you are interested in and click "submit".

Fields listed with an * are required.

Required *

  • * First Name
  • * Last Name
  • * Address
  • * City
  • * State
  • * ZIP Code
  • Phone Number: By supplying my phone number, I grant permission for a sales representative to call me
  • Email
  • * I am interested in receiving the following enrollment kit(s):

  • Comments