SeniorCare and SeniorCare Rx Application

To obtain an application packet:

• Download an application packet . Please print and complete the required forms and mail to a Scott & White Health Plan office near you.
• Or request an application packet to be mailed to you.
• Or call 1-800-782-5068 or visit a Scott & White Health Plan office near you.

After we receive your application, we will send your request for coverage to the Centers for Medicare and Medicaid Services (CMS) for final approval. The process may take six weeks or more. You will be notified in writing regarding your acceptance and starting date for SeniorCare. Do not cancel any other coverage until you have received confirmation in writing of your acceptance for the SeniorCare plan.

The above information is current as of November 2007.

SeniorCare is offered by Scott & White Health Plan, a State-Certified Health Maintenance Organization with a Medicare Cost Contract.

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