Enroll in Erickson Advantage

How to Enroll

Please contact your Erickson Advantage Licensed Sales Agent located in the Erickson Advantage office located on your campus.

Enrollment forms are located below—your Erickson Advantage Licensed Sales Agent will assist you in deciding which plan may best meet your needs.

Signature with Drugs, English | Spanish

Signature Without Drugs, English | Spanish

Champion, English | Spanish

Freedom, English | Spanish

Guardian, English | Spanish

Before completing an enrollment form, please read the disclaimer information provided.


What You Need to Know About Your Medicare Advantage Plan

Enrollment guides are located below—your Erickson Advantage Health Resource Manager will assist you in deciding which plan may best meet your needs.

Signature with Drugs, English | Spanish

Signature Without Drugs, English | Spanish

Champion, English | Spanish

Freedom, English | Spanish

Guardian, English | Spanish


How to Become an Authorized Representative For Your Friend or Family Member

To become an authorized representative, you'll need to download and print the Appointment of Representative Form. Both you and the person you wish to represent will need to sign the form.

APPOINTMENT OF REPRESENTATIVE FORM
DOWNLOAD NOW


The Erickson Advantage Welcome Call

After enrollment in the Erickson Advantage plan with or without Prescription Benefits, you can expect a welcome call from the Erickson Advantage Member Services representative to:

  • Verify all of your contact information.
  • Review information you will be receiving about your health care status.
  • Verify you have an appointment with your primary care physician.

New Member Orientation Meeting

It may be beneficial for you and/or a family member to attend a new member orientation meeting. This meeting focuses on how you can best maximize all the services available to you as an Erickson Advantage plan member with or without Prescription Benefits.

At this meeting, we will:

  • Review your covered Medicare benefits.
  • Explain the additional services beyond Medicare you receive including care coordination services and health education/wellness programs.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1 of each year.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan's contract renewal with Medicare.

You must continue to pay your Medicare Part B premium.

This information is available for free in other languages. Please call our customer service number at 1-866-314-8188, TTY 711, 8 a.m. - 8 p.m. local time, 7 days a week.

Esta información está disponible sin costo en otros idiomas. Comuníquese con nuestro Servicio al Cliente al número 1-866-314-8188, TTY 711, de 8 a.m. – 8 p.m. hora local, los 7 días de la semana.

For more information on Erickson Advantage, just stop by the office Monday through Friday 8:30 a.m.-5:00 p.m. or call 1-866-774-9671, TTY: 711. 8 a.m. - 8 p.m. local time, 7 days a week.

Please read the UnitedHealthcare Non-Discrimination Notice.

Language Assistance/Non-Discrimination Notice