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Medicare Forms & Fliers
2025 Documents
2025 Pre-Enrollment Forms
2025 Permission to Contact Form (PDF) English | Spanish |
2025 Scope of Appointment (PDF) English | Spanish |
2025 PreEnrollment Checklist (PDF) English | |
2025 PPO Documents
2025 Presales Book – Complete (PDF) English | Spanish |
2025 Presales Book - Complete and Essential (PDF) English | Spanish |
2025 Presales Book- Salute (PDF) English | Spanish |
2025 Enrollment Form – Complete and Essential (PDF) English | Spanish |
2025 Enrollment Form – Salute (PDF) English | Spanish |
2025 Summary of Benefits – Complete (PDF) English | Spanish |
2025 Summary of Benefits – Essential (PDF) English | Spanish |
2025 Summary of Benefits – Salute (PDF) English | Spanish |
2025 HMO-SNP Documents
2025 Enrollment Form – DualPrime (PDF) English | Spanish |
2025 Presales Book – DualPrime (PDF) English | Spanish - Coming Soon |
2025 Summary of Benefits – DualPrime (PDF) English | Spanish - Coming Soon |
Medicare Advantage Post-Enrollment Forms
Prescription Claim Form (PDF) |
Appointment of Personal Representative (PDF) |
MedPlus Agent Contracting
Agent/Agency Update Form (PDF) General Agency Use |
General Agency Contacts for New Agents (PDF) |
Consumer Direct Products Independent Contractor Form (PDF) Agent Use |
MedPlus Pre-Enrollment
Replacement of Coverage Form (PDF) |
Broker Acknowledgement Form (PDF) |
Pre-Sales books: |
MedPlus Post-Enrollment
MedPlus Household Discount Request Form (PDF) |
Membership Change Form (PDF) |
Reinstatement Request Form (PDF) |
Authorization for Access to Personal Information (PDF) HIPAA release |
General
Medicare Advantage
Medicare Advantage Supplemental Vendors
Nations Hearing
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SilverSneakers Fitness
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Blue365 Flier (PDF) |
MedPlus
MedPlus Sales Brochure (DC) (PDF) |
MedPlus Sales Brochure (VA) (PDF) |
MedPlus Sales Brochure (MD) (PDF) |
Medicare & MedPlus 2023 Updates (PDF) |
CareFirst Dental - It's the Right Decision Flier (PDF) |
SilverSneakers Fitness
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Blue365 Flier (PDF) |