How to Enroll

What you need to know before you enroll

• Enrollment periods
• Eligibility requirements and additional information
• Information you need 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

1. Click a link below to go to an online enrollment form for the plan you have selected.
2. By filling out an online enrollment form, you'll be sending an enrollment request to PriorityMedicare^SM.
3. Look for a "thank you" confirmation page after you submit your online enrollment form. If you don't see the "thank you" confirmation, please call us at the numbers listed below.
   

• PriorityMedicare Value^SM
  
• PriorityMedicare
  
• PriorityMedicare Plus^SM
• PriorityMedicare Rx^SM
  

Haven't selected a plan yet?

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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 on the plan name to print and mail in the 2009 enrollment form:

• I certify that I have read the eligibility information. Download the enrollment form for PriorityMedicare Value (59KB PDF)
• I certify that I have read the eligibility information. Download the enrollment form for PriorityMedicare (59KB PDF)
• I certify that I have read the eligibility information. Download the enrollment form for PriorityMedicare Plus (59KB PDF)
• I certify that I have read the eligibility information. Download the enrollment form for PriorityMedicare Rx (53KB PDF)

Make sure you sign the enrollment form and make a copy for your records.

Mail the original form to us at:

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

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