Forms (Click for Copy)
MEDICARE ENROLLMENT: Social Security Administration
Employment Verification: Must be presented to Social Security Office when enrolling in Medicare when older than 65 and coming off group coverage.
SCOPE of Appointment: Must be signed and available at each appointment with one of our staff. Notice that we do not charge for our services.
Low-Income Subsidy: For Drug assistance subsidy

Apply for Coverage

Regence BCBS PPO & HMO 2017:  Online application.

United Health Care AARP: Online application
  • Plan 1    (Click to Print Benefits)
  • Plan 2    (Click to Print Benefits)          
  • Plan 3   (Click to Print Benefits)
Health Net Violet Option (Call for assistance)
HUMANA  (Call for assistance)
Providence (Call for assistance)

Mutual of Omaha G Plan: Paper app or call us.
Transamerica F and G Plan: Paper app, call us.

    Website Builder provided by  Vistaprint