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Find a Form

Find the Forms You Need Fast.

 We know you're busy, so we've made the forms you need easily accessible.  Please click on the pdf link and download your forms.  

Plan Summary Forms

SecureOne Plan - Brochure & Enroll Form (pdf)Download
SecureOne Dental - Individual Plan Summary (pdf)Download
SecureOne Dental Costs (pdf)Download
SecureOne Dental - Orthodontic Plan Services (pdf)Download
SecureOne Vision - Individual Plan Summary (pdf)Download
SecureOne Telemedicine - Plan Summary (pdf)Download
SecureOne Hearing - Individual Plan Summary (pdf)Download
SecureOne Chiro & Complementary Health Plan (pdf)Download
SecureOne Prescriptions - Plan Summary (pdf)Download

Enrollment & Admin Forms

Using your SecureOne Plan (pdf)Download

Broker Forms

SecureOne Producer Agreement (pdf)Download

 THIS PLAN IS NOT INSURANCE and is not intended to replace health insurance.  This plan does not meet the minimum creditable coverage requirements under M.G.L. c.111M and 956 CMR 5.00. This plan is not a Qualified Health Plan under the Affordable Care Act.  This is not a Medicare prescription drug plan. The range of discounts will vary depending on the type of provider and service. The plan does not pay providers directly. Plan members must pay for all services but will receive a discount from participating providers. The list of participating providers is at www.secureoneplans.com. A written list of participating providers is available upon request.  Discount Plan Organization and administrator: Careington International Corporation, 7400 Gaylord Parkway, Frisco, TX 75034; phone 800-441-0380.  This plan is not available in  WA, UT, VT and MA.  


Discount Medical Plan Organization and Administrator: SecureOne Plan, 4745 N 7th Street, Suite 120 Phoenix AZ 85014; phone 888-429-0914.
The program and its administrators have no liability for providing or guaranteeing service by providers or the quality of service rendered by providers 

Copyright © 2022 SecureOne Plan - All Rights Reserved.

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