CaliforniaChoice New Hire Enrollment Quote Request (CC 0170)-2026

1. Click ‘Get Form’ to open the CaliforniaChoice New Hire Enrollment Quote Request (CC 0170) in our editor.
2. Begin by filling out the Employer Information section. Enter the date, name of the requestor, telephone number, group number, and employer name accurately.
3. Proceed to the Employee Information section. Here, you must provide details for each employee including their last name, first name, middle initial, birth date, residence zip code, gender, hire date, and whether to show rates before or after employer contribution.
4. If adding dependents only, refer to your rate guide as instructed. Ensure all required fields are completed for processing.
5. In the Delivery Instructions section, specify where materials should be mailed by entering the recipient's name and mailing address.
6. Finally, review all entries for accuracy before submitting. Once complete, fax the form to (714) 558-8000 as indicated.

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