A Healthy CollaborationSM

Caregivers

Checklist for Plan Enrollment

Prior to enrolling someone in your care into a PrescribaRx plan, please be sure to have the following information ready:

  • Know which PrescribaRx plan best fits his or her needs
  • Beneficiary's first, middle and last name (spelled correctly)
  • Beneficiary's date of birth
  • Beneficiary’s home phone number including area code
  • Beneficiary’s permanent street address
  • The mailing address to which all correspondence will be sent (this could be yours or the beneficiary’s)
  • Emergency contact information (this could be you or another person)
  • Beneficiary’s Medicare card
  • Any additional medical or prescription plan information, if applicable
  • Social Security or checking account information if premiums will be deducted directly from an account

 

S5597_S5825_C0008_09P0043_v2 (09/2009) Last updated: 09/09/2022

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