Change is asae alan} eae Ger ena nen nee) No need to start from scratch. No need to order and wait. And you don't need to fill out a new application to make changes to member plans. In an effort to better record changes to Today's Options® plans, and keep our members’ status current, a brief 2008 Change Notice Form is now available electronically for download. To make a change, simply download, print and fill out the Change Notice Form. Use it to indicate: ‘* Members switching to a different Todays Options plan* +A change in premium payment option * Updates to contact information You may download the form at www.todaysoptions.com. “Fleas noe tha if members changing thei plan because he/she s switching to another ‘one of our licensed companies, you wll noed fo complete an ently new application, not Sichange form. Any change in “11” numbers requiesfilng out a new application. Be sure to fill out the Change Notice Form in its entirety and print legibly, providing information for each section as indicated below. 2008 Change Notice Form a eee Personal Information ~ As you complete this portion, don't forget to write in the members ‘most recent contact information. Bets guste we ons ey. ‘Medicare Claim Number — Remember to include the Medicare Claim number—also called Health Insurance Claim (HIC) number— ‘exactly as it appears on the enrollee’ red, white ‘and blue Medicare card, plus any letters that ‘appear before or after the number. Plan & Premium — Make sure you check off the plan the member would like to change to, not the plan he or she currently has. Write in the correct premium amount, rs ne Payment Options ~ The member may choose from the following forms of payment: Bank daft, direct bill or Social Security deduction. Bank drafts highly recommended. If bank dkaftis chosen: The member needs to complete the automatic bank craft section and attach a voided check to verify bank account information. (Deposit sips are not acceptable.) son ie ising Sis [Sse (over please) TO CN Explain 1107 For agent use only.an Aart Ei to in OOH sete ern ips asta hp ton ‘Member Signature & Date - Have the member sign their name here Authorized Representative This portion is only to be filled outby the person legally authorized to represent the enrollee. Note: the agent snot the authorized representative ‘Address Update - Write in the member's most recent address and con't forget to fill in the count. Its crucial for assigning the enrollee monthly payments, ‘Agent Signature ~ Place your own signature here. ‘gt notre "ty One L Plan Name & Election Period ~Fll in the new plan name. Be sure to check off the election period for which the form is being completed Choose appropriately: AEP (Annual Election Period); ICEP (Initial Coverage Election Period); SEP (Special Election Period); OEP (Open Election Period). Tl a tea er tts Sars Gpeas SNOT 7 NSE anor Mailing Address - Once you've made your changes, mail the completed Change Notice Form to: id Life >O. Box 742528 Houston, TX 77274 ‘American Progressive PO. Box 7426i6 Houston, 1X 77274 Topay’s OPTIONS"