How to Enroll
PrescriptionMail Service
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Find Your Location
View contact information forall 18 Erickson Advantage locations.
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Website Rights and Responsibilities
We want you to get the best possible information and care so that you can take charge of your health.
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What You Need to Know About Your Medicare Advantage Plan
How to Become an Authorized Representative
The Erickson Advantage Welcome Call
New Member Orientation Meeting
For more information on Erickson Advantage, stop by the office Monday–Friday, 8:30 a.m.–5:00 p.m. or call 1‑800‑644‑1557, TTY:711 from 8:30 a.m.–5:00 p.m. local time, Monday–Friday.
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.
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
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.
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:
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:
Click here for Disclaimer Information.