Medicare Part D - 2008 Enrollment Forms

Medicare Part D: Introduction to Enrollment

• What does this cost me?
  There is no additional cost for our services - you will always pay the same price for a Medicare Part D plan, no matter where you enroll and you receive exactly the same coverage.
• Why should I call National Insurance Markets?
  Some of you may wish to ask a few last minute questions or require help with the enrollment forms. Again, there is no additional cost.
• Can I send the enrollment form directly to the Insurance Company?
  Sure, you can complete, sign, and mail the enrollment form directly to the Medicare Part D plan provider. However, if you send your enrollment form to us, we will check it for mistakes or omitted information and then send the enrollment form directly to your chosen Insurance Company.

Medicare Part D 2008 Enrollment Forms

• compare premiums,
• view/download the Summary of Benefits,
• view/download the drug Formularies (list of covered drugs); so that you can make sure the drugs you take will be covered in your plan,
• download plan Enrollment Forms so that you can easily enroll in a new plan should you find a plan that more affordably provides you with prescription drug coverage.

How do I enroll in a Medicare Part D plan?

• Step 1: We will send an enrollment kit via eMail or by U.S. mail
• Step 2: Print the Enrollment Form, if received by eMail
• Step 3: Complete and sign the Simple Enrollment Form
  • Having problems? We can help - Give our Agents a call and we can answer your questions, or fill out the enrollment form for you and mail it to you - 1-800 322-8467
• Step 4: Once you have completed and signed the enrollment form, make a copy for your records. Then please mail the original to:

Download your Aetna Part D Enrollment Form

Download Enrollment Form

Download your Cigna Part D Enrollment Form

Download 2008 Enrollment Form

Download your Community Care Rx (CCRx) Part D Enrollment Form

Download 2008 Enrollment Form

Download your Coventry Advantra Rx Enrollment Kit

Download Enrollment Form

Humana Enrollment via Telephone

1. The information exactly as it appears on your Medicare Card (name, Medicare claim number, Parts A and/or B effective dates and gender.
2. Mailing address
3. eMail address
4. Selected Humana plan
5. Proposed effecive date

Download your Prescription Pathway Enrollment Kit

Download Enrollment Form

Download your Sierra Rx Enrollment Kit

Download the UnitedHealth Rx Enrollment Form

Download Enrollment Form

Download the WellCare PDP Enrollment Form

Download the WellCare Enrollment Form

Download the 2008 WellCare Enrollment Form

Additional WellCare Enrollment Information

• WellCare Pharmacy Finder
• WellCare Member Rights and Responsibilities
• WellCare Conditions and Limitations
• WellCare Privacy & Legal
• WellCare Formulary Updates

WellCare Forms, Pharmacy and Provider Resources