Member Services: 1-800-838-8271 TTY: 711

To enroll by phone call: 1-800-838-5914

Enrollment

If you are interested in learning more about Imperial Health Plan of California (HMO) (HMO SNP) please contact our prospective member toll-free line at: 1-800-838-5914.

Want to enroll in Imperial Health Plan, you can do so in one of the following ways:
  1. Enroll over the phone by calling us at 1-800-838-5914 and we will take your enrollment information over the phone
  2. Schedule a face-to-face appointment by calling 1-800-838-5914 and we can schedule an appointment with an employed Sales Representative or Independent Agent.
  3. Download the attached enrollment forms (see links below) and submit via:
  1. Complete online enrollment application via Medicare Online Enrollment Center (OEC) at http://www.medicare.gov. By accessing this link, you acknowledge that you have reviewed the Imperial Health Plan Summary of BenefitsDrug Formulary, and the Provider Search Function that are provided on https://imperialhealthplan.com or by calling the Membership Department at 1-800-838-8271.

If you detect or suspect FWA, please report it immediately. Your report is confidential and prohibits retaliation against anyone for reporting in good faith a possible violation of the code, law or regulation.

2023

2023 Important Notification - Please add the Agent Signature Page along with the Enrollment forms.

Enrollment Documents

If you select PBP 005 Imperial Senior Value (HMO C-SNP), you must complete the SNP Assessment Form below.

Who can join? To join any of our Plan Benefit Packages, you must meet all of the following requirements:
  • You live in our service area
  • You have both Medicare Part A and Medicare Part B
  • You are a United States Citizen and/or lawfully present in the United States
To join Imperial Senior Value (C-SNP), you must also have been diagnosed with diabetes, chronic heart failure (CHF), and/or cardiovascular disorders(s).

To join Imperial Dual Plan (HMO D-SNP), you must have both Medicare and Medicaid.

If you’re enrolled in a Medicare plan or enrolling for the first time, generally you can only enroll, switch plans, or disenroll from a plan during certain times of the year.

Annual Election Period (AEP)

AEP is from October 15 through December 7 of every year. MA eligible individuals may enroll in or disenroll from an MA plan. The last enrollment request made, determined by the application date, will be the enrollment request that takes effect.

Initial Coverage Election Period (ICEP)

The ICEP is the period during which an individual newly eligible for MA may make an initial enrollment request to enroll in an MA plan. This period begins three months immediately before the individual’s first entitlement to both Medicare Part A and Part B and ends on the later of:

  1. The last day of the month preceding entitlement to both Part A and Part B, or;
  2. The last day of the individual’s Part B initial enrollment period.

Initial Enrollment Period for Part D (IEP for Part D)

The Initial Enrollment Period for Part D (IEP for Part D) is the period during which an individual is first eligible to enroll in a Part D plan. In general, an individual is eligible to enroll in a Part D plan when he or she is entitled to Part A OR is enrolled in Part B, AND permanently resides in the service area of a Part D plan. Ultimately, CMS provides a part D eligibility effective date and maintains it in CMS systems.

Open Enrollment Period for Institutionalized Individuals (OEPI)

The OEPI is continuous for eligible individuals. For purposes of enrollment under the OEPI election period, an institutionalized individual is defined as an individual who moves into, resides in, or moves out of an institution. The OEPI ends two months after the month the individual moves out of the institution.

Special Election Periods (SEP)

Special election periods constitute periods outside of the usual IEP, AEP or MA OEP when an individual may elect a plan or change his or her current plan election. As detailed below, there are various types of SEPs, including SEPs for dual eligible, and for individuals whose current plan terminates, who change residence and who meet “exceptional conditions”.

Medicare Advantage Open Enrollment Period (MA OEP)

Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MA-PD or MA-only plans can switch to:

  • MA-PD
  • MA-only
  • Original Medicare (with or without a stand-alone Part D plan)

The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.

2022

Enrollment Documents

If you select PBP 005 Imperial Senior Value (HMO C-SNP), you must complete the SNP Assessment Form below.

Who can join? To join any of our Plan Benefit Packages, you must meet all of the following requirements:
  • You live in our service area
  • You have both Medicare Part A and Medicare Part B
  • You are a United States Citizen and/or lawfully present in the United States
To join Imperial Senior Value (C-SNP), you must also have been diagnosed with diabetes, chronic heart failure (CHF), and/or cardiovascular disorders(s).

To join Imperial Dual Plan (HMO D-SNP), you must have both Medicare and Medicaid.

If you’re enrolled in a Medicare plan or enrolling for the first time, generally you can only enroll, switch plans, or disenroll from a plan during certain times of the year.

Annual Election Period (AEP)

AEP is from October 15 through December 7 of every year. MA eligible individuals may enroll in or disenroll from an MA plan. The last enrollment request made, determined by the application date, will be the enrollment request that takes effect.

Initial Coverage Election Period (ICEP)

The ICEP is the period during which an individual newly eligible for MA may make an initial enrollment request to enroll in an MA plan. This period begins three months immediately before the individual’s first entitlement to both Medicare Part A and Part B and ends on the later of:

  1. The last day of the month preceding entitlement to both Part A and Part B, or;
  2. The last day of the individual’s Part B initial enrollment period.

Initial Enrollment Period for Part D (IEP for Part D)

The Initial Enrollment Period for Part D (IEP for Part D) is the period during which an individual is first eligible to enroll in a Part D plan. In general, an individual is eligible to enroll in a Part D plan when he or she is entitled to Part A OR is enrolled in Part B, AND permanently resides in the service area of a Part D plan. Ultimately, CMS provides a part D eligibility effective date and maintains it in CMS systems.

Open Enrollment Period for Institutionalized Individuals (OEPI)

The OEPI is continuous for eligible individuals. For purposes of enrollment under the OEPI election period, an institutionalized individual is defined as an individual who moves into, resides in, or moves out of an institution. The OEPI ends two months after the month the individual moves out of the institution.

Special Election Periods (SEP)

Special election periods constitute periods outside of the usual IEP, AEP or MA OEP when an individual may elect a plan or change his or her current plan election. As detailed below, there are various types of SEPs, including SEPs for dual eligible, and for individuals whose current plan terminates, who change residence and who meet “exceptional conditions”.

Medicare Advantage Open Enrollment Period (MA OEP)

Individuals may add or drop Part D coverage during the MA OEP. Individuals enrolled in either MA-PD or MA-only plans can switch to:

  • MA-PD
  • MA-only
  • Original Medicare (with or without a stand-alone Part D plan)

The effective date for an MA OEP election is the first of the month following receipt of the enrollment request.

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