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Get Enrollment Form Wisconsin

Llow the steps outlined and review the important notes below before filling out your form. You can also apply online or over the phone. See back page for more information. Step 1: Select your desired combination of medical and prescription drug coverage. It s important to understand if you are eligible to enroll in prescription drug coverage prior to filling out this form. If you re unsure, please call Medicare Sales at the numbers on the back of this form. Step 2: Select your plan.

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