Rates
	Four Important Reasons
	Eligibility & Guaranteed Acceptance
	Additional Provisions
	Summary of Benefit
	Frequently Asked Questions
	Glossary
	Medicare Update
	Printed Information and Applications
	Best Benefits Discount Program - Including Emergency Travel Service
	Express Scripts Pharmacy Benefit Card
	About Medicare Advantage
	Social Security & Medicare Fact Sheet
	Medicare Part D Information

Mail Me A Personalized Enrollment Kit

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Print Out An Enrollment Kit:
Adobe PDF Formatted
Rates not included in this version.
However, you can find your rate here.
(If you just need the application form, see below.)

Main Application: Part I
Complete this pdf form for all Plan Options.
Click here for an html version of the document.

Automatic Payment: Part II Pre-authorized check payment pdf form for payment from your checking account. Click here for an html version of this document.

Authorization for Electronic Claims Payment: Part III Complete this form when you enroll to set up paperless claims processing for your Medicare Part B expenses. Click here for an html version of this document.

FRS Form: Florida Residents: To pay via deductions from your Florida Retirement System pension check. Click here for an html version of this document.

Click here to find the cost of Medicare Supplement Programs for your state.