How to Enroll:
- Download the 2021 Harvard Pilgrim enrollment form (pdf) and Instructions (pdf)
- 2021 Pre-Enrollment Checklist (Important Disclaimers)
- Medicare beneficiaries may also enroll in Harvard Pilgrim StrideSM (HMO) through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov (This link takes you away from the Harvard Pilgrim website.)
Medicare Plan Ratings
The Medicare Program rates all health and prescription drug plans each year, based on a plan’s quality and performance. Some of the areas Medicare reviews for these ratings include:
- How our members rate our plan’s services and care;
- How well our doctors detect illnesses and keep members healthy; and
- How well our plan helps our members use recommended and safe prescription medications.
Safeguarding Your Privacy
- Member Notice of Privacy Practices (pdf)
- Medicare Appointment of Representative form (AOR) (pdf)
Use this form to authorize a friend, relative or other individual to make a request on your behalf (Organization Determination, Coverage Determination, Appeal or Grievance).
- Designation of Representation Form (pdf)
Use this form to give our Member Services representatives the right to speak with another individual about your plan. We may also accept other legal documents you may have like a Power of Attorney, Guardianship or Health Care Proxy.
- Member Authorization Release Form (pdf)
Use this form to allow a short term or one-time release of your health information to another individual or entity (for example, an attorney or another insurance company).
Applying for Extra Help
Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car.
If you qualify, you get help paying for any Medicare drug plan’s monthly premium, yearly deductible, and prescription copayments. This “Extra Help” also counts toward your out-of-pocket costs. People with limited income and resources may qualify for “Extra Help.” Some people automatically qualify for “Extra Help” and don’t need to apply. Medicare mails a letter to people who automatically qualify for “Extra Help.”
You may be able to get “Extra Help” to pay for your prescription drug premiums and costs. To see if you qualify for getting “Extra Help,” call 24 hours a day/7 days a week:
Getting Care During a Disaster
If the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to care from your plan.
Generally, if you cannot use a network provider during a disaster, your plan will allow you to obtain care from out-of-network providers at in-network cost-sharing. If you cannot use a network pharmacy during a disaster, you may be able to fill your prescription drugs at an out-of-network pharmacy.
Ending Your Membership
You might leave our plan because you have decided that you want to leave. There are only certain times during the year, or certain situations, when you may voluntarily end your membership in the plan. Please review this document to learn about disenrolling from your StrideSM Medicare Advantage (HMO) plan.
Ending your membership in our plan.
Links on this page may take you away from the Harvard Pilgrim Health Care website.
Y0098_21111 Last Update: 10/1/20