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.

Liberty Without Drugs, Download the 2020 Liberty Without Drugs Enrollment Request Form in English PDF Opens in a new window Download the 2020 Liberty Without Drugs Enrollment Request Form in Spanish PDF Opens in a new window

Liberty with Drugs, Download the 2020 Liberty with Drugs Enrollment Request Form in English PDF Opens in a new window Download the 2020 Liberty with Drugs Form in Spanish PDF Opens in a new window

Freedom, Download the 2020 Freedom Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Freedom Plan Enrollment Request Form in Spanish PDF Opens in a new window

Signature, Download the 2020 Freedom Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Freedom Plan Enrollment Request Form in Spanish PDF Opens in a new window

Champion, Download the 2020 Champion Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Champion Plan Enrollment Request Form in Spanish PDF Opens in a new window

Guardian, Download the 2020 Guardian Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Guardian Plan Enrollment Request Form in Spanish PDF Opens in a new window

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.

Liberty without Drugs, Download the 2020 Signature with Drugs Enrollment Request Form in English PDF Opens in a new window Download the 2020 Signature with Drugs Form in Spanish PDF Opens in a new window

Liberty with Drugs, Download the 2020 Signature Without Drugs Enrollment Request Form in English PDF Opens in a new window Download the 2020 Signature Without Drugs Enrollment Request Form in Spanish PDF Opens in a new window

Freedom, Download the 2020 Freedom Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Freedom Plan Enrollment Request Form in Spanish PDF Opens in a new window

Signature, Download the 2020 Freedom Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Freedom Plan Enrollment Request Form in Spanish PDF Opens in a new window

Champion, Download the 2020 Champion Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Champion Plan Enrollment Request Form in Spanish PDF Opens in a new window

Guardian, Download the 2020 Guardian Plan Enrollment Request Form in English PDF Opens in a new window Download the 2020 Guardian Plan Enrollment Request Form in Spanish PDF Opens in a new window


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.


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.

At this meeting, we will:

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

Click here for Disclaimer Information.