IMPORTANT: Enclosed in your new member packet, you will find a "Schedule of Benefits" which represents the Accidental Death & Dismemberment policy that comes with your AHCA membership.

If you have not already done so, this form should be returned to our office immediately for beneficiary verification. Please complete, sign and return to: AHCA, P.O. Box 3190, Cerritos, California 90703-3190.

PLEASE PRINT