STAGE DEV MAY, 2013

Enroll in our Medicare Advantage Plans Form

Three easy steps to enroll

  1. Check eligibility
  2. Choose a plan type
  3. Apply for enrollment

Enrollment Instructions for CCHP Senior Program (HMO)  Chinese  Spanish

Enrollment Instructions for CCHP Senior Select Program (HMO SNP)  Chinese  Spanish

 

Step 1: Check eligibility

Anyone who has both Medicare Parts A and B may enroll in CCHP Medicare Advantage HMO plans, including people under age 65 with disability. You must live within CCHP's service area for respective plans.

There are no medical screenings, and your health status, with the exception of end-stage renal disease (ESRD), does not affect your eligibility.

Step 2: Type of Plans

  • CCHP Senior Program (HMO)
    Anyone who is eligible/enrolled in Medicare Part A and Part B and lives within San Francisco and northern San Mateo Counties may apply. Eligible Medicare beneficiaries may enroll in CCHP Senior Program (HMO) during specific times of the year.
  • CCHP Senior Select Program (HMO SNP)
    Anyone who is eligible/enrolled in Medicare Part A and Part B, receives Medi-Cal benefits, and lives within San Francisco County may apply.

Step 3: Apply for Enrollment

When you're ready to enroll, you can do one of the following:

  • Download our Enrollment Form  Chinese  Spanish. Fill out the form and mail it to the address listed on the form. If you need assistance, please call 415-955-8800, ext. 3256.
  • Attend a free sales seminar where you will learn about the benefits of our Medicare Advantage HMO plans and enroll.

Once we receive your application, we'll process it. You should receive your confirmation in about 2 weeks.

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Learn More

To find out more about CCHP Medicare Advantage HMO plans offered in your area or to check the status of your application, you can contact us at 415-955-8800, ext. 3256, Monday through Friday, 8:00 a.m. to 8:00 p.m. Hearing impaired please call TTY 1-877-681-8898.

Exceptions and special circumstances

There are some exceptions that allow you to enroll in CCHP Senior Program (HMO) during the year. You may be able to enroll if one of the following special circumstances applies to you:

  • You recently became eligible for Medicare.
  • You were enrolled in a plan and recently moved.
  • You entered a nursing home.
  • You are entitled to both Medicare and Medi-Cal. If you are entitled to benefits under Medi-Cal, consider our CCHP Senior Select Program (HMO SNP).
  • You recently qualified for Medicare's low-income subsidy program, which provides extra help paying for prescription drug costs .
  • You are disenrolling from an employer group health plan.
  • You involuntarily lost creditable prescription drug coverage.

For more information, please contact Medicare. You can call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-486-2048. You can also visit the Medicare website(http://www.medicare.gov). (By clicking on this link, you will leave CCHP's Medicare Advantage plan website.)

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Request more information

For additional information, call 415-955-8800, ext. 3256 or TTY 1-877-681-8898 for the hearing impaired, Monday through Friday, 8:00 a.m. to 8:00 p.m.

Attend a free seminar

To learn more about CCHP Senior Program (HMO) or CCHP Senior Select Program (HMO SNP), we invite you to attend a free seminar. A sales representative will be present to discuss our plans and answer your questions. Check our Seminar Schedule for the next upcoming seminar.

A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-888-681-3888 (TTY 1-877-681-8898).

Make a personal appointment

If you can’t make it to one of our seminars, please contact our sales team. Just call 415-955-8800, ext. 3256 to set up a personal appointment.

Online: Fill out the form below and someone will be in touch with you.

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