Print the Enrollment Packet - 2010

Before You Enroll

Please read the following information to learn more about our Plan before you enroll:

• Welcome Letter (PDF)

• 2010 Summary of Benefits (PDF)

• 2010 Member Guide (PDF)

• Benefit Chart (PDF)

• Translation Sheet (PDF)

Download the Enrollment Form

Click on one of the links below to download our enrollment form. Once you have completed this form, please mail it to us at:

Passport Advantage HMO
ATTN: PAD Enrollment
305 West Broadway
Louisville, KY 40202
Or, you can fax it to us at (502) 585-8338.

• English Enrollment Form (PDF)

Passport Advantage is a health plan with a Medicare contract. This Plan is available to all active Passport Health Plan members with Medicare Parts A and B. For full information on Passport Advantage benefits call Member Services. The content on this website is available in alternate formats, such as Braille, large type, or another language. Please call us at 1-800-578-0603, then press 1 (TTY: 1-800-648-6056), 7 days a week from 8 a.m. to 8 p.m. to request another format.