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Individual Product Forms and Literature

Please provide your client with all materials in each product section for a complete packet.

Individual Plans

Medicare Advantage (PPO) and Part D Prescription Plans

Regence MedAdvantage + Rx Enhanced (PPO), Regence MedAdvantage + Rx Classic (PPO) and Regence MedAdvantage (PPO)

  • Enrollment Form
  • Short Enrollment Form (for existing members to upgrade their plan)
    All pages of this form must be given to inquiring or applying individuals.

Medicare Script Enhanced (PDP) and Medicare Script (PDP)

  • Enrollment Form

Medicare Companion (Medigap) Plans

View and print information for Oregon residents

View and print information for Clark County, Washington residents.

Claim Forms
Miscellaneous Forms

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