2019 Helpful Information / How to Enroll
How to Enroll:
- Download the 2019 Harvard Pilgrim enrollment form (pdf) and Instructions (pdf)
- Medicare beneficiaries may also enroll in Harvard Pilgrim Stride SM (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 Representative Statement 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:
TTY users should call (877) 486-2048
You can also apply at the Social Security Office (800) 772-1213, between 7 a.m. to 7 p.m, Monday through Friday. TTY users should call 1-800-325-0778 or Your State Medicaid Office.
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.
Harvard Pilgrim is an HMO plan with a Medicare contract. Enrollment in StrideSM (HMO) depends on contract renewal. This information is not a complete description of benefits.Call Member Services at 1-888-609-0692 for more information. TTY users please call 711.
Links on this page may take you away from the Harvard Pilgrim Health Care website.
|Y0098_19172||Last Update: 10/23/18|