Forms

Here you’ll find forms relating to your Medicare plan. If you have any questions, or if you’re unable to find what you’re looking for, contact us.

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Forms for Medicare plans

Please choose the type of form you need from the following list.

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  • Turning 65?

    Get real answers to all your questions! We’ll teach you about how Medicare works and give you tips and ideas to make sure you’re ready to go on day

  • HAP's 5K Challenge

    Get a discount to run one of our 5K Challenge races.

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Copyright © 2017 HAP
2017 Health Alliance Plan of Michigan
Y0076_ALL_2018029 Website MP
CMS Approved: 6/26/2017
Last Update: 6/21/2017

HAP Senior Plus HMO, HMO-POS, and PPO are health plans with a Medicare contract. Enrollment in these plans depends on contract renewal. HAP Senior Plus PPO is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP. Alliance Medicare Supplement is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP.

This information is not a complete description of benefits. Contact the plan for more information. Limitation, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and or provider network may change at any time. You will receive notice when necessary.

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Contact us

  • (800) 868-3153 TTY: 711

  • HAP Senior Plus®

    (800) 801-1770 TTY: 711

  • HAP Senior Plus® (PPO)

    (888) 658-2536 TTY: 711

  • Alliance Medicare Supplement:

    (800) 873-7526 TTY: 711