C and O Employees' Hospital Association

 

 

Click on the link below for Enrollments Forms:

 

Medicare Enrollment Form:

Medicare Supplemental Application 2017.pdf

2017 Star Ratings Template.pdf

2016 Creditable coverage letter.docx

Retired Enrollment Form:

2017 Retirement Application.pdf

Method of Payment Form:

Method of Payment Form.pdf

Coordination of Benefits Form:

COORDINATION OF BENEFITS QUESTIONNAIRE.doc

 

NEW MEMBERS