Enroll in PriorityMedicare Rx

What you need to know before you enroll

• Enrollment periods
• Eligibility requirements and additional information
• Information to have available before enrolling
• Confirmation of your enrollment
  
  

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Enrollment options

Choose how you'd like to enroll: online, by phone or by mail.

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Enroll online

• By filling out this online enrollment form, you certify that you are losing your employer-provided coverage as of Jan. 1, 2009.
• Click the button below to send your enrollment request to PriorityMedicare Rx^SM.
• You'll receive an e-mail confirmation that we've received your enrollment form. We'll contact you to let you know if you've been enrolled.

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Enroll by phone

• 616 464-8850 or toll-free 888 389-6676
  8:30 a.m. to 5:00 p.m., Monday through Friday
• Hearing- or speech-impaired TTY/TDD:
  616 464-8485, or toll-free 888 551-6761
  8:30 a.m. to 5:00 p.m., Monday through Friday

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Enroll by mail

Click this link to print and mail in the 2009 enrollment form:

• I certify that I've read the eligibility information. Download the form for PriorityMedicare Rx now. (53KB PDF)
  

Sign the enrollment form and mail it to us at:

Priority Health, MS 1125
1231 East Beltline NE
Grand Rapids, MI 49525

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