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Missing AARP Membership Number
If an AARP Membership Number is not displaying above, please provide the Application #
By clicking the Submit button below, you the agent/agent's representative agree the information is accurate and was provided by the applicant, and you are submitting this change request on their behalf.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Missing Guaranteed Issue Documents
Your total document size maximum has exceeded 9.5MB.
You have uploaded too many documents. The maximum accepted is 5 documents.
You have attached an incorrect file format. Files must be a PDF, JPG, JPEG or PNG.
Your file did not upload successfully. Please try again.
By clicking the Submit button below, you the agent/agent's representative agree the information is accurate and was provided by the applicant, and you are submitting this change request on their behalf.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Missing Legal Forms (FL, IL, KY, OH)
Your total document size maximum has exceeded 9.5MB.
You have uploaded too many documents. The maximum accepted is 5 documents.
You have attached an incorrect file format. Files must be a PDF, JPG, JPEG or PNG.
Your file did not upload successfully. Please try again.
By clicking the Submit button below, you the agent/agent's representative confirm the agent completed the legal enrollment form with the applicant and agree the information is accurate.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Missing Part A or Part B Effective Date
If an AARP Membership Number is not displaying above, please provide the Application #
By clicking the Submit button below, you the agent/agent's representative agree the information is accurate and was provided by the applicant, and you are submitting this change request on their behalf.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Missing Replacement Notice
Your total document size maximum has exceeded 9.5MB.
You have uploaded too many documents. The maximum accepted is 5 documents.
You have attached an incorrect file format. Files must be a PDF, JPG, JPEG or PNG.
Your file did not upload successfully. Please try again.
By clicking the Submit button below, you the agent/agent's representative confirm the agent completed the Replacement Notice with the applicant and agree the information is accurate.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Plan Selection Change (Pending Application)
By clicking the Submit button below, you the agent/agent's representative agree the information is accurate and was provided by the applicant, and you are submitting this change request on their behalf.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Missing Date of Birth
If an AARP Membership Number is not displaying above, please provide the Application #
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Change Requested Plan Effective Date
By clicking the Submit button below, you the agent/agent's representative agree the information is accurate and was provided by the applicant, and you are submitting this change request on their behalf.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Provide Health Question Responses
Your total document size maximum has exceeded 9.5MB.
You have uploaded too many documents. The maximum accepted is 5 documents.
You have attached an incorrect file format. Files must be a PDF, JPG, JPEG or PNG.
Your file did not upload successfully. Please try again.
By clicking the Submit button below, you the agent/agent's representative confirm the agent completed the Health and Tobacco questions with the applicant and agree the information is accurate.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Missing Phone Number
By clicking the Submit button below, you the agent/agent's representative agree the information is accurate and was provided by the applicant, and you are submitting this change request on their behalf.
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Missing Application Pages
If an AARP Membership Number is not displaying above, please provide the Application #
Your total document size maximum has exceeded 9.5MB.
You have uploaded too many documents. The maximum accepted is 5 documents.
You have attached an incorrect file format. Files must be a PDF, JPG, JPEG or PNG.
Your file did not upload successfully. Please try again.
By clicking the Submit button below, you the agent/agent's representative confirm the agent completed the missing application page(s) with the applicant and agree the information is accurate.
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Withdraw Pending Application
If an AARP Membership Number is not displaying above, please provide the Application #
Thank you for submitting your request!
Your change request for the above Applicant has been submitted.
Upon clicking on the Close button or the "X" in the upper right corner, you will be returned to the Service Request screen. From there you can choose another request for the same client or continue with the other activities.
Important Documents
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Missing/Incomplete Application
Update Request Form (For MA/PDP only) opens in a new window -
AARP Med Supp General Information Change
(Form 1) opens in a new window -
AARP Med Supp Insured
Information Change (Form 2) opens in a new window - AARP Med Supp Back Termination and Refund Request (Form 3) opens in a new window
- AARP Med Supp Pending Apps (Form 4) opens in a new window
- AARP Med Supp Plan Changes (Form 4PC) opens in a new window
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Missing/Incomplete Application
Saturdays through 12/2/2023, 8am - 5pm CST
Sunday 10/15/2023 and 12/3/2023, 8am - 5pm CST
Saturdays from 10/28/2023 - 1/13/2024, 8am - 5pm CST
Sunday 1/14/2024, 8am - 5pm CST