Enrollment Forms

Download a printable enrollment form to mail or fax to us. Start by selecting the plan you would like to enroll in and download the enrollment form:

Medicare Advantage Health Maintenance Organization (HMO) Plans
Generations Healthcare HMO Offered in Canadian, Cleveland, Grady, Lincoln, Loga, Mclain, Oklahoma, Pottawatomie, and Seminole Counties in Oklahoma. Generations Healthcare Enrollment Form
TexanPlus^® HMO (North Texas) Offered in Collin, Dallas, Rockwall, Tarrant counties in Texas. TexanPlus (North Texas) Enrollment Form
TexanPlus^® HMO (Southeast Texas) Offered in Austin Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Waller counties in Texas. TexanPlus (Southeast Texas) Enrollment Form
Today's Options^® HMO Offered in Hamilton, Johnson and Marion counties in Indiana. Today's Options HMO Enrollment Form

Medicare Advantage Health Maintenance Organization (HMO) Plans

Generations Healthcare HMO

Offered in Canadian, Cleveland, Grady, Lincoln, Loga, Mclain, Oklahoma, Pottawatomie, and Seminole Counties in Oklahoma.

Generations Healthcare Enrollment Form

TexanPlus^® HMO (North Texas)

Offered in Collin, Dallas, Rockwall, Tarrant counties in Texas.

TexanPlus (North Texas) Enrollment Form

TexanPlus^® HMO (Southeast Texas)

Offered in Austin Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Waller counties in Texas.

TexanPlus (Southeast Texas) Enrollment Form

Today's Options^® HMO

Offered in Hamilton, Johnson and Marion counties in Indiana.

Today's Options HMO Enrollment Form

Medicare Advantage Preferred Provider Organization (PPO) Plans
Today's Options^® PPO Offered in Arkansas, Georgia, Indiana, Iowa, Maine, Mississippi, Missouri, Montana, Nebraska, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Texas, Virginia, and Wisconsin. Please follow these steps to download the Enrollment Form for your Service Area: Select your State from the first dropdown box below Select your County from the second dropdown box below Click "Submit" The link to the Enrollment Form will appear below. Click on the link to open the Enrollment Form You can click "Reset" at any time to start over.

Medicare Advantage Preferred Provider Organization (PPO) Plans

Today's Options^® PPO

Offered in Arkansas, Georgia, Indiana, Iowa, Maine, Mississippi, Missouri, Montana, Nebraska, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Texas, Virginia, and Wisconsin.

Today's Options PPO Enrollment Form - Kit 31 Today's Options PPO Enrollment Form - Kit 32 Today's Options PPO Enrollment Form - Kit 33 Today's Options PPO Enrollment Form - Kit 34 Today's Options PPO Enrollment Form - Kit 35 Today's Options PPO Enrollment Form - Kit 36 Today's Options PPO Enrollment Form - Kit 37 Today's Options PPO Enrollment Form - Kit 38 Today's Options PPO Enrollment Form - Kit 39

Medicare Advantage Private Fee-for-Service (PFFS) Plans
Today's Options^® PFFS Offered in Arizona, Arkansas, California, Colorado, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, Tennessee, Texas, Vermont, Virginia, Washington, and Wisconsin. Please follow these steps to download the Enrollment Form for your Service Area: Select your State from the first dropdown box below Select your County from the second dropdown box below Click "Submit" The link to the Enrollment Form will appear below. Click on the link to open the Enrollment Form You can click "Reset" at any time to start over.

Medicare Advantage Private Fee-for-Service (PFFS) Plans

Today's Options^® PFFS

Offered in Arizona, Arkansas, California, Colorado, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, Tennessee, Texas, Vermont, Virginia, Washington, and Wisconsin.

Today's Option PFFS Summary of Benefits Kit 21 (PDF)Today's Option PFFS Summary of Benefits Kit 22 (PDF)Today's Option PFFS Summary of Benefits Kit 23 (PDF)Today's Option PFFS Summary of Benefits Kit 24 (PDF)Today's Option PFFS Summary of Benefits Kit 25 (PDF)Today's Option PFFS Summary of Benefits Kit 26 (PDF)Today's Option PFFS Summary of Benefits Kit 27 (PDF)Today's Option PFFS Summary of Benefits Kit 28 (PDF)

Medicare Advantage Network Private Fee-for-Service (PFFS) Plans
Today's Options^® PFFS Offered in Arkansas, Georgia, Indiana, Iowa, Maine, Mississippi, Missouri, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Texas, Virginia, and Wisconsin. Please follow these steps to download the Enrollment Form for your Service Area: Select your State from the first dropdown box below Select your County from the second dropdown box below Click "Submit" The link to the Enrollment Form will appear below. Click on the link to open the Enrollment Form You can click "Reset" at any time to start over.

Medicare Advantage Network Private Fee-for-Service (PFFS) Plans

Today's Options^® PFFS

Offered in Arkansas, Georgia, Indiana, Iowa, Maine, Mississippi, Missouri, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Texas, Virginia, and Wisconsin.

Today's Options Network PFFS Enrollment Form - Kit 1Today's Options Network PFFS Enrollment Form - Kit 2Today's Options Network PFFS Enrollment Form - Kit 3Today's Options Network PFFS Enrollment Form - Kit 4Today's Options Network PFFS Enrollment Form - Kit 5Today's Options Network PFFS Enrollment Form - Kit 6Today's Options Network PFFS Enrollment Form - Kit 7Today's Options Network PFFS Enrollment Form - Kit 8Today's Options Network PFFS Enrollment Form - Kit 9

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