Please complete this form to help us learn a little more about you. We will contact you by phone to follow up about your application to join the CAC.
Note: Your responses to these questions will NOT affect your current enrollment or benefits, and they will not change whether you are selected to join the CAC. Your individual responses will be kept private.
Please provide your name, preferred phone number and zip code so that we may contact you about your interest in joining the CAC.
*Indicates a required field
The following questions tell us a little about you.
What is your gender identity?
What is the primary language spoken at home?
Tufts Health One Care is a health plan that contracts with both Medicare and Medicaid (MassHealth) to provide benefits of both programs to enrollees.
Thank you for your interest in the Tufts Health One Care CAC. If you are selected to join the CAC, a member of our Community Engagement team will reach out with more information.