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The below form may not be used for membership cancellations.
Please contact our Customer Care Department at 1-800-337-1421
for detailed instructions to cancel your membership.
 

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Last Name
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SureHealth transition programs are not available in: CT, KS, MN, MT, NH, SD, VT and WA

Please refer to the effective date on your new membership ID card(s), as of the date shown,
Insurance benefits are underwritten by American Medical & Life Insurance Company.
Exclusively Distributed by Oxonia Insurance Group, Inc. d/b/a/ Oxonia Insurance agency in CA, MI, NY, and VA.

© 2005-2006 All rights reserved, Oxonia Insurance Group, Inc. d/b/a/ Oxonia Insurance agency in CA, MI, NY, and VA.
P.O. Box 15398 • Plantation, FL 33318 • Toll Free: (800) 337.1421 • Fax: (954) 315.6325