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Sales Call Form

This form is for Sales Calls being transferred to our External Call Center at 346-206-0309.

Ensure you gain verbal agreement from the caller to be transferred.

Caller Information

* Required

First Name

Last Name

Email

Phone Number

Notes:

Service Agent Name

Caller has granted permission to be transferred. [PROSPECT MUST PROVIDE CLEAR CONFIRMATION (E.G., YES, YEA, OF COURSE).]

*Every year, Medicare evaluates plans based on a 5-star rating system. KCA is the only 5-star plan that allows enrollment outside of SNP eligibility **The One Pass program varies by plan/area and includes a standard fitness membership. Access to gym and fitness location network may vary by location and plan. ^†https://health.usnews.com/medicare. KelseyCare Advantage, a product of KS Plan Administrators, LLC, is an HMO and POS Medicare Advantage plan with a Medicare contract. Enrollment in KelseyCare Advantage depends on contract renewal. This information is not a complete description of benefits. Call for more information: prospective members, call (713)-442-5646 (TTY: 711), October 1 – March 31, 8 a.m. - 8 p.m. CT, seven days a week; or April 1 – September 30, 8 a.m. - 8 p.m. CT, Monday through Friday. Medicare beneficiaries may also enroll in KelseyCare Advantage online at https://www.kelseycareadvantage.com/enroll or through the CMS Medicare Online Enrollment Center located at https://www.medicare.gov/. Limitations, copayments, and restrictions may apply. You must continue to pay your Medicare Part B premium Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Benefits and coverage vary by plan.

© 2024 KelseyCare Advantage. All rights reserved. H0332_1258137559DM_M

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