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Welcome
Welcome to the 2024 Online Enrollment for Harvard Pilgrim's Medicare Supplement plan for Massachusetts, New Hampshire, and Maine. By completing the following screens, you will be sending an actual enrollment request to the HPHC Insurance Company. (Form #'s: MA1481-3, NH1482-3, ME1483-3)

Medicare Supplement Enrollment

Applicant First Name

Applicant Last Name

Suffix

DOB (MM/DD/YYYY)

Please refer to your red, white and blue Medicare Card:

Part A (Hospital) Effective Date

Part B (Medical) Effective Date

Residential Zip

Please select your anticipated effective date of coverage from the drop down list. This date cannot be more than 2 months
in the future and must be either: the first of the following month or your Medicare Part B effective date.

Broker ID (If enrollment will be facilitated by a broker)

Broker's Name

Continue

For more information, call 1-877-909-4742, Monday through Friday 8:30 a.m. - 5:00 p.m., TTY: 711.

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