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FirstCommunity Senior Select ENROLLMENT APPLICATION For Attained Age Medicare Supplement This application is for effective dates on or after January 1, 2020. INSTRUCTIONS Please print with a ballpoint
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How to fill out firstcommunity senior select enrollment
How to fill out firstcommunity senior select enrollment
01
Obtain the FirstCommunity Senior Select Enrollment form.
02
Fill out your personal information accurately, including your full name, address, date of birth, and contact information.
03
Provide your insurance details, including your plan number and policy holder information.
04
Indicate your preferred coverage options, such as medical, dental, and vision.
05
Review the enrollment form for any errors or missing information.
06
Sign and date the form to confirm your enrollment.
07
Submit the completed enrollment form either online or by mail, following the instructions provided by FirstCommunity.
Who needs firstcommunity senior select enrollment?
01
FirstCommunity Senior Select Enrollment is intended for senior individuals who are seeking comprehensive insurance coverage.
02
It is suitable for those who are looking for medical, dental, and vision insurance options specifically designed for seniors.
03
People who want access to a network of healthcare providers and specialized services may benefit from enrolling in FirstCommunity Senior Select.
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What is firstcommunity senior select enrollment?
FirstCommunity Senior Select Enrollment is a program available for seniors that allows them to enroll in a specific health care plan that provides tailored benefits for their needs.
Who is required to file firstcommunity senior select enrollment?
Individuals who are eligible seniors, typically aged 65 and older, and those who wish to enroll in the FirstCommunity Senior Select plan must file for enrollment.
How to fill out firstcommunity senior select enrollment?
To fill out the FirstCommunity Senior Select Enrollment, individuals need to obtain the enrollment form, provide personal information, health information, and indicate their preferred plan options before submitting it.
What is the purpose of firstcommunity senior select enrollment?
The purpose of FirstCommunity Senior Select Enrollment is to facilitate access for seniors to health care plans that provide comprehensive coverage and specialized services suitable for their age group.
What information must be reported on firstcommunity senior select enrollment?
The enrollment form requires reporting personal identification information, contact details, health status, income information, and any existing insurance coverage.
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