Alliance Medicare Supplement

Please read the application form carefully.

Answer the questions completely.

Eligible Medicare beneficiaries reside in the state of Michigan.

Submitting your application through the online process constitutes a valid request on your part to purchase an Alliance Medicare Supplement policy. In the event of an omission on the application form, you will be contacted by a Health Alliance Plan representative.

If you lost or are losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement insurance policy, forward a copy of the notice.

Mail:

HAP MEDICARE SOLUTIONS
HEALTH ALLIANCE PLAN
2850 W. GRAND BLVD.
DETROIT, MI 48202

OR

Fax: 248-443-4424

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