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Dear Applicant,
Thank you for your interest in Reliance Plus for your dental, vision, and hearing needs. We appreciate the opportunity
to become your insurer of choice.
This Enrollment Application is for Reliance Plus. This plan is in addition to your current Medicare Supplement plan you
have with Capital Advantage Insurance Company (CAIC) and will require a separate monthly premium. With this plan you will
receive additional dental, vision, and hearing benefits.
Instructions for completing the Enrollment Application are included with each section. To avoid delays in processing
your request, please ensure that required information is completed.
A material misrepresentation of facts may lead to cancellation or voidance of coverage.
NEXT STEPS
We will review your enrollment application and make the determination to approve or decline it. All details of our
review will be kept confidential. If your enrollment application is approved, you will receive an approval letter. If
your enrollment application is declined, you will receive a declination letter.
Questions: If you have any questions and/or need help filling out this enrollment application, please contact us at
888.732.4968.
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