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

Online application. 

PacificSource HMO: (Click Here and Call for assistance)
Online application.

UnitedHealthcare® : (Call for assistance)
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.

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