Discount Medical Plan Application
24-Hour Nurse Line, Dental, Diabetes Supplies, Hearing, Podiatry, Prescriptions, and Vision

We Value Your Privacy
Your membership materials will arrive within 7 to 10 business days after your application is processed.

You can cancel within 30 days after receipt of membership materials and receive a full refund, less the processing fee.

FL Residents: You can cancel within 30 days of the effective date and receive a full refund, less the processing fee.

Send written cancellation requests to Careington: PO Box 2568, Frisco TX 75034; or fax to: 888 335-7330 or email: member@careington.com.

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Careington International Corporation, Medical - Dental Discount Plans, Frisco, TX

Member Information
* Denotes Required Field
*First Name   Initial
*Last Name   Suffix
*Address
 
*City
*State
This program may not be available in all States
*Zip Code -
*Home Phone --
Work Phone --
*E-Mail Address
*Date of Birth
*Gender
Marital Status
Number of
Members

Additional members besides enrollee
*Select Your Union
Marketing Code If you heard about us by mail,
please enter the marketing code referenced on the
back of the application form

  I am interested in receiving future offers for other products or services from Careington.
  I am interested in receiving future offers for other products or services from Union Plus.
  I have reviewed the terms and conditions and wish to purchase the discount medical plan.

Desired Billing Cycle

Member + Family
 $69.95 annually
   
*Effective Date

Payment Method
Credit/Debit Card
Bank Draft/Electronic Check



FORM CODE CICONLINEAPP
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This is not health insurance.
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