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Exhibit 1:OMB No. 09381378 Expires: 6/30/2026MODEL INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C)Who can use this form? People with Medicare who want to join a
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01
Gather all necessary personal information including full name, date of birth, and address.
02
Obtain your Social Security number or Medicare number if applicable.
03
Complete the member agreement form by reading the terms and signing where required.
04
Fill out the health history section, providing accurate information about any existing conditions.
05
Review and provide emergency contact information.
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Submit the documents as instructed, whether online or via mail.

Who needs zing health member documents?

01
Individuals who are enrolling in Zing Health insurance plans.
02
Anyone experiencing changes in their health coverage needing to update their information.
03
Medicare beneficiaries seeking supplemental health benefits through Zing Health.
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Zing Health member documents are official documents that provide essential information regarding the coverage, benefits, and responsibilities of members enrolled in Zing Health plans.
Members enrolled in Zing Health plans are required to file zing health member documents to ensure compliance with the health coverage requirements.
To fill out zing health member documents, members should provide accurate personal information, health details, and any other required documentation as specified by Zing Health.
The purpose of zing health member documents is to document the health plan coverage, ensure that members understand their benefits, and fulfill regulatory requirements.
The information that must be reported includes personal identification details, coverage start and end dates, types of coverage, and any relevant health conditions.
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