RESOURCE CENTER

Installation Forms
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10.31.2012
2013 Medigap Security (GROUP) Employee application
2013 Application employee or retiree must complete to enroll in a Group sponsored Medigap Security plan. Group rates are also required and both should be sent to your account manager 30 days in advance of effective date.
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10.31.2012
2013 Keystone 65 (GROUP) Employee application
2013 Application employee or retiree must complete to enroll in a Group sponsored Keystone 65 plan. Group rates are also required and both should be sent to your account manager 30 days in advance of effective date.
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10.31.2012
2013 PPO 65 (GROUP) Employee application
2013 Application employee or retiree must complete to enroll in a Group sponsored Personal Choice 65 plan. Group rates are also required and both should be sent to your account manager 30 days in advance of effective date.
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10.31.2012
2013 Select Option PDP (GROUP) Employee application
2013 Application retiree must complete to enroll in a Group sponsored PDP plan. ONLY RETIREES MAY ENROLL. Group rates are also required and both should be sent to your account manager 30 days in advance of effective date.
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10.15.2012
2013 Scope of Sales Appointment Confirmation form
Form to be completed by Medicare beneficiary in order for an certified agent to be able to discuss Medicare Advantage and Medicare Part D plans with a Medicare beneficiary.
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11.22.2011
2012 Non-Group IBC Medicare - Cover Sheet
Required form for installation/submission of Individual IBC Medicare IBC Advantage or Prescription products.
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11.22.2011
Scope of Sales Appointment Confirmation form
*Required for Group or Ind installation. Form to be completed by Medicare eligible in order for a certified agent to be able to discuss Medicare Advantage and Medicare Prescription Drug plans with a Medicare beneficiary.
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11.22.2011
Medigap Security - 2012 Employee application
2012 Application employee or retiree must complete to enroll in IBC Medigap plan
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11.22.2011
Keystone 65 (group) - 2012 Employee application
2012 Application employee or retiree must complete to enroll in Keystone 65 plan
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11.22.2011
Personal Choice 65 (group) - 2012 Employee application
2012 Application employee or retiree must complete to enroll in Personal Choice 65
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11.22.2011
Select Option (group) - 2012 Employee application
2012 Application retiree must complete to enroll in Select Option PDP plan
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10.24.2011
CMS Secret Shopper Checklist
CMS on occassion will have a secret shopper act as an interested Medicare Beneficiary at your group marketing/sales events. This checklist for your review, providing you a glimpse at what they will look for you as an agent to be compliant on.
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10.11.2011
2012 Non-Group PPO 65 Change form
2012 change form to be completed by Medicare beneficiary to change products within Individual PPO Medicare. AEP is from 10/15/11 thru 12/7/11. For Disenrollment or SEP, ask your Account Manager.
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10.11.2011
2012 Non-Group Keystone 65 Change form (for Montco, Delco, Chester Counties)
2012 change form to be completed by Medicare beneficiary (who resides in Montco, Delco, and Chester) to change products within Individual Keystone Medicare. AEP is from 10/15/11 thru 12/7/11. For Disenrollment or SEP, ask your Account Manager.
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10.11.2011
2012 Non-Group Keystone 65 Change form (for Bucks & Phila. Counties)
2012 change form to be completed by Medicare beneficiary (who resides in Bucks or Philadelphia county) to change products within Individual Keystone Medicare. AEP is from 10/15/11 thru 12/7/11. For Disenrollment or SEP, ask your Account Manager.
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