If you are an individual and are ready to enroll in one of our Medicare Advantage Plans, you can enroll by:
- Downloading the Enrollment Form, completing the form, and mailing it to the plan.
Complete all sections on the form including your signature.
Mail completed form and documentation to:
Simply Healthcare Plans
1701 Ponce de Leon Blvd.
Coral Gables, Florida 33134 or
- Complete and submit your Enrollment Form on the Medicare website at www.medicare.gov
2012 Enrollment Application - English
2012 Enrollment Application - Spanish
Click on the link to download the Enrollment Application.
By completing and sending this enrollment election form to be enrolled you are sending an actual enrollment election to Simply Healthcare Plans.
Once the plan receives your enrollment election form, and prior to submitting the enrollment transaction to CMS, the plan will contact you (via phone or mail) to confirm that you still intend to enroll in the plan.
If your enrollment election form is incomplete, the plan may need to contact you to acquire additional information to complete your election.
The plan will send you an acknowledgement letter notifying you that it has received your enrollment election and has submitted the transaction to CMS for processing.
After the plan receives confirmation from CMS , the plan will send you one of the following letters:
- Confirmation letter notifying that you are enrolled in the plan
- Rejection of enrollment letter.
