The following are the items necessary concerning any new enrollment,
termination or change for a group. To download a form, right-click a link below and choose "Save Target As..." from the menu.
Fillable PDF forms allow you to enter information directly on the form and then save an electronic copy of the form. After saving the form you can then print, sign and either mail or fax the form to HPS.
These documents are provided in the Adobe Acrobat PDF format for which you will need the Acrobat Reader program 
or plug-in. If you don't already have Acrobat Reader, you can download it free by clicking this button.
* Note: The Medicare Part D Creditable Coverage Letter is a sample Microsoft Word document that you may use as a template or guide.
