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Enrollment Application 2017

Instructions and Disclaimers

Here is how you can enroll in a Preferred Care Partners plan NOW:

1. Download, print and complete form with signature: 

         Application Instructions for plans above

         Application Instructions

 If you are enrolling in Preferred Special Care Miami-Dade (HMO SNP), you  must fill out the Chronic Condition Pre-Assessment Form.
 Click  here to download.  

         Application Instructions 

       Please mail or fax to:

United Healthcare Medicare Enrollment
Attn: Xerox/ACS
3315 Central Ave.
Hot Springs, AR, 71913

Fax: 1-501-262-7070

2. OR- Complete and submit your Enrollment Form via the Medicare website

By completing and sending the enrollment election form to be enrolled, you are sending an actual enrollment election to Preferred Care Partners.

You must complete and sign an enrollment election form. Except for forms that are faxed to our plan, you should submit original, not photocopied forms.

Once we receive your enrollment election form, and prior to submitting the enrollment transaction to CMS, we 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, we may need to contact you to acquire additional information to complete your election.

After submitting the enrollment transaction to CMS, we may send you an acknowledgement letter notifying you that we have submitted the transaction to CMS for processing.

After we receive confirmation from CMS' systems of the enrollment transaction, we will send you one of the following letters:

  • Confirmation letter notifying that you are enrolled in the plan.
  • Denial of enrollment letter.
  • Rejection of enrollment letter. 

Election Periods and Conditions for Enrollment

Below are the periods and conditions when a Medicare eligible individual may apply for enrollment in one of our plans.

  • Annual Election Period (AEP)- from October 15 through December 7
  • Initial Coverage Election Period (ICEP) is for all newly-eligible Medicare beneficiaries. This period starts three months immediately before the individual's entitlement to Medicare Part A and enrollment in Medicare Part B

 Medicare Website

Medicare beneficiaries may enroll in Preferred Care Partners through the CMS Medicare Online Enrollment Center, located at www.medicare.gov.

NOTE: Medicare beneficiaries with special exceptions, such as those who have Medicaid coverage or chronic conditions, can enroll at any time during the year. Contact us for additional information.


Need Assistance Completing This Form?

Phone

1 (877) 485-5595 - Toll-Free
TTY users call toll-free 711

Fax

1 (501) 262-7070

Hours

8 a.m. to 8 p.m.,
7 days a week, including holidays

Email

Enroll@uhcsouthflorida.com

Enrollment disclaimer information

Preferred Care Partners is insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. Medicare beneficiaries may also enroll in Preferred Care Partners through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. Medicare has neither reviewed nor endorsed this information. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Consult a health care professional before beginning any exercise program. Availability of the SilverSneakers program varies by plan/market. Refer to your Evidence of Coverage for more details. Healthways and SilverSneakers are registered trademarks of Healthways, Inc. and/or its subsidiaries. ©2015 Healthways, Inc. All rights reserved.