AARP Medicare Supplement Application - Colorado Health Agents

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The SilverSneakers program is made available as a value added service to AARP members insured by UnitedHealthcare. Neither AARP nor UnitedHealthcare endorse or are responsible for the services or information provided by this program. Consult a health care professional before beginning any exercise program. EyeMed Vision Care (EyeMed) is the network administrator of AARP Vision Discounts. These discounts cannot be combined with any other discounts, promotions, coupons, or vision care plans. Products or services that are reimbursable by federal programs including Medicare and Medicaid are not available on a discounted or complimentary basis. EyeMed pays a royalty fee to AARP for use of the AARP intellectual property. Amounts paid are used for the general purposes of AARP and its members. Cannot be combined with any other offer, previous purchases, or vision and insurance plans. Some restrictions apply. Some brands excluded. See store for details. Void where prohibited. Valid at participating locations. The Sears trademark is registered and used under license from Sears Brands LLC. Target Optical ® is a registered mark of Target Brands, Inc. used under license. OptumHealth is the provider of Nurse HealthLine. OptumHealth nurses cannot diagnose problems or recommend specific treatment and are not a substitute for your doctor’s care. All decisions about medications, vision care, and health and wellness care are between you and your health care provider. AARP doesn’t make individual recommendations for health-related products, services, insurance or programs. You are encouraged to evaluate your needs and compare products. AARP Medicare Supplement Insurance Plans are insured by UnitedHealthcare Insurance Company, Horsham, PA. Policy Form No. GRP 79171 GPS-1 (G-36000-4). In some states, plans may be available to persons eligible for Medicare by reason of disability. All plans may not be available in your state/area. Not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation of insurance. An agent may contact you. AARP and its affiliate are not insurance agencies or carriers and do not employ or endorse insurance agents, producers, brokers, representatives or advisors. See the enclosed brochure for complete information including benefits, costs, eligibility requirements, exclusions and limitations. 0000001 0000026 0052 0074 UMS1129 01 L
Enrollment Checklist In the following section, you will find the forms you need to complete when applying for coverage. Please be sure to complete and submit all the necessary forms to ensure your enrollment is processed quickly and accurately. Here is an overview of the different forms and some helpful tips: Application Form • Be sure to review and complete each applicable section. • Please only write comments where indicated on the application. Written comments in other areas of the form will slow down processing of the application. • Be sure to sign and date the application in all the places indicated. The agent must also sign and date the application and include his or her agent identification number. AARP Membership Form AARP membership is required to enroll in an AARP Medicare Supplement Plan. If you are not currently an AARP member, simply complete the membership form and submit with the plan application, along with a separate check for $16.00 payable to AARP. Automatic Payments Authorization Form Automatic payments are available by submitting the completed form (signed and dated) and a voided check. If requesting automatic payments, you can deduct $2 from the first month’s premium check. Notice to Applicants Regarding Replacement of Coverage If you are replacing current coverage as indicated on the form, complete both copies of the form, submit one copy with the enrollment application, and keep the other copy for your records. The agent must also sign and date both copies of the form. SA25124ST (10-10) 0000001 0000027 0053 0074 UMS1129 01 L
Page 1 and 2: Colorado AARP Medicare Supplement I
Page 3 and 4: Instructions Page Please Read Befor
Page 5 and 6: Hello, Thank you for your interest
Page 7 and 8: Your Plans and Rates AARP ® Medica
Page 9 and 10: Cover Page - Rates for Colorado - A
Page 25 and 26: Outline of Coverage | UnitedHealthc
Page 27 and 28: Your Guide to AARP Medicare Supplem
Page 51: Your Exclusive Member Services. Get
Page 55 and 56: Application Form AARP ® Medicare S
Page 57 and 58: 5 Answer these health questions to
Page 59 and 60: 7 Tell us about your past and curre
Page 61 and 62: 8 Authorization and Verification of
Page 63 and 64: AARP membership offers so much for
Page 65 and 66: Save $24 a year with the Electronic
Page 67 and 68: Save $24 a year with the Electronic
Page 69 and 70: NOTICE TO APPLICANT REGARDING REPLA
Page 71 and 72: 0000001 0000036 0071 0074 UMS1129 0
Page 73 and 74: Thank You for Applying for an AARP

AARP Medicare Supplement Application - Colorado Health Agents

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