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PW_B130703
Direct Payment HMO/POS
How to Enroll
Read the enrollment instructions. Print and fill out the application then submit the materials along with proof of residence. Or contact sales at 1-800-385-2041, Monday - Friday 8:30 a.m. - 5:00 p.m. EST for more information. A completed application received by the 15th of the month will be effective the first day of the following month. Applications received after the 15th of the month will be effective the first day of the month after that.
Please be sure to indicate your coverage choice for the HMO/POS contract in question # 11.
Cost
No payment is required with your application; a bill for the cost of your monthly premium rate will be mailed to you once you are enrolled.
Direct Payment Health Maintenance Organization
How to Enroll
Read the enrollment instructions. Print and fill out the application then submit the materials along with proof of residence. Or contact sales at 1-800-385-2041, Monday - Friday 8:30 a.m. - 5:00 p.m. EST for more information. A completed application received by the 15th of the month will be effective the first day of the following month. Applications received after the 15th of the month will be effective the first day of the month after that.
Please be sure to indicate your coverage choice for the Direct Payment HMO contract in question # 11.
Cost
No payment is required with your application; a bill for the cost of your monthly premium rate will be mailed to you once you are enrolled.
Traditional PLUS Hospital
How to Enroll
Read the enrollment instructions. Print and fill out the application then submit the materials along with proof of residence. Or contact sales at 1-800-385-2041, Monday - Friday 8:30 a.m. - 5:00 p.m. EST for more information. Your coverage will become effective the date your completed application and required documentation is received.
Cost
No payment is required with your application; a bill for the cost of your quarterly premium will be mailed to you once you are enrolled.
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