Enrollment 2013

You may enroll in the plan or make changes to coverage you already have only during specific times of the year.

• When you first become eligible for Medicare or when you turn age 65, during your Initial Enrollment Period.
• During certain open enrollment periods that happen every year from October 15 until December 7.
• Under certain circumstances that qualify you for a Special Enrollment Period (SEP), such as:
  • You move
  • You’re eligible for Medicaid
  • You qualify for Extra Help with Medicare prescription drug costs
  • You’re getting care in an institution, such as a skilled nursing facility or long-term care hospital

The enrollment period for the Medicare Advantage Plans is from October 15 until December 7, but if you are a Medicare Beneficiary with Part A and B and have medical assistance from the state you can join First Plus Platino at any time during the year.

Do not complete the enrollment form unless you have already reviewed the Summary of Benefits.

In this section you will find the Enrollment forms for each of our plans. If you have already reviewed the Summary of Benefits and wish to enroll now, just click on the plan below to print out the Enrollment Form.

Please complete each form, but do not sign it until you read the second page (back of the form). Once you have read the second page and agree with the information provided, then sign and date the form and mail it to:

Enrollment Department
P.O.Box 195080
San Juan, PR 00919

PPO

• First+Plus Advantage
  H4011_FP_13_1070_01_I CMS Approved 09/13/2012
• First+Plus Advantage Plus
  H4011_FP_13_1070_01_I CMS Approved 09/13/2012

PPO EMPLOYER

• First+Plus Gobierno Premium
  H4011_FP_GOB_13_1070_01_I FYI
• First+Plus Gobierno VIP
  H4011_FP_GOB_13_1070_01_I FYI
• First+Plus Gobierno Plus
  H4011_FP_GOB_13_1070_01_I FYI

HMO

• First Care Plus
  H5887_FP_13_1070_01_I CMS Approved 09/13/2012
• First+Plus Smart Plus
  H5887_FP_13_1070_04_I CMS Approved 09/13/2012
• First+Plus Smart Premium
  H5887_FP_13_1070_04_I CMS Approved 09/13/2012

HMO SNP

• First+Plus Complete
  H5887_FP_13_1070_02_I CMS Approved 09/13/2012
• First+Plus Platino
  H5887_FP_13_1070_03_I CMS Approved 09/13/2012

PDP

• Pharma Plus
  S5840_FP_13_1070_01_I CMS Approved 09/13/2012
• Pharma Premium
  S5840_FP_13_1070_01_I CMS Approved 09/13/2012
• PDP Gobierno
  S5840_FP_GOB_13_1070_01_I FYI