- enrollment kits
- 2024 Enrollment Kits for Pennsylvania
2024 Enrollment Kits for Pennsylvania
The enrollment kit is a ZIP file of PDF materials. These materials can be used to enroll or email clients. Kits are available in English and Spanish, and include the following materials:
- Enrollment Form
- C-SNP Verification Form (if applicable)
- Scope of Appointment Form
- Summary of Benefits
- Star Ratings Insert
- Plans at a Glance*
- Getting Started Flyer
- OTC Catalog
- Covered Dental Codes
If you use these forms, you’ll need to print and have your clients physically sign them before mailing or faxing them to us.
Download the kit you plan to use
Pennsylvania
Counties: Berks, Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, Philadelphia
Having trouble with your ZIP files? Learn how to extract or unzip your files.
Want a paper enrollment package?
Order your offline paper enrollment package in the marketing storefront.
*The Plans at a Glance in the enrollment kit are not approved for use in provider offices or at pharmacy counters. We offer customizable Plans at a Glance through the marketing storefront that are approved for use in provider offices and pharmacy counters.