SeniorCare (Cost) Plan H4564 Application for Coverage*
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. |
Request an application packet to be mailed to you. | Call 1-800-782-5068 or TTY/TDD users call 800-735-2989 Monday - Sunday, 8 a.m. to 8 p.m. CST, 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 (Cost). Do not cancel any other coverage until you have received confirmation in writing of your acceptance for the SeniorCare (Cost) plan.
The above information is current as of October 2009.
*SeniorCare (Cost) Plan is offered by Scott & White Health Plan, a State-Certified Health Maintenance Organization with a Medicare Cost Contract.
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