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OMB No. 09381378 Expires: 7/31/2023 EXHIBIT 1: MODEL INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C) OR MEDICARE PRESCRIPTION DRUG PLAN (PART D) Who can use this

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How to fill out join or switch plans

01

Review your current plan details including coverage and costs.

02

Research available join or switch plans suitable for your needs.

03

Compare the benefits and premiums of the new plans.

04

Check eligibility requirements for switching plans.

05

Gather necessary personal and financial information.

06

Contact your current provider to understand the switching process.

07

Fill out the application form for the new plan accurately.

08

Submit the application before the enrollment deadline.

09

Confirm the switch with your new provider and receive your new plan details.

Who needs join or switch plans?

01

Individuals looking for better coverage options.

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New enrollees who are exploring insurance options.

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Individuals approaching the end of a current contract or plan.

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What is join or switch plans?

Join or switch plans refers to the process where individuals can enroll in a new insurance plan or change their current plan, typically during specified enrollment periods.

Who is required to file join or switch plans?

Individuals who wish to change their current health insurance plan or enroll in a different one during the designated enrollment periods are required to file join or switch plans.

How to fill out join or switch plans?

To fill out join or switch plans, individuals need to complete the required enrollment application form, providing personal information, current plan details, and preferences for the new plan.

What is the purpose of join or switch plans?

The purpose of join or switch plans is to allow individuals to select a health insurance option that better suits their needs or to ensure they have coverage that aligns with their healthcare requirements.

What information must be reported on join or switch plans?

The information that must be reported includes personal identification details, current insurance plan information, desired coverage options, and any relevant financial details.

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