The below form should be completed for all new enrollments or changes.  Please fill out the form by clicking the link and submitting it when done.
 

• Enrollment/Change Form  

 
If you have Medicare Part A and B, please complete the Aetna Medicare Advantage form or the KelseyCare Advantage form by clicking the appropriate link of choice below. When submitting one of these forms, the Enrollment/Change form above must be submitted as well for a complete enrollment.
 

• Aetna Medicare Advantage Form
• KelseyCare Advantage Form

• Current Rates
• Medical Benefit Summary
• Common-Law Certificate
• Retirement Exit Form
• Qualifying Events Per HIPPA Law