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Medicare Advantage Individual Enrollment Election Form

For assistance, give us a call at (877) 778-1855 (TTY users should call 711).

Hours are from 8 a.m. to 8 p.m., seven days a week from October 1 through February 14. After February 14, your call will be routed to our after-hours service on weekends and holidays.

Please contact ONECare if you need information in another language or format.

Enrollment Form:

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H5430_18_024_MK CMS Approved Pending

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