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Every SCAN employee is trained to understand the needs of people with Medicare, to help you make an informed decision about your Medicare needs.
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Enrollment Forms

Download the appropriate enrollment form and print the form. Then complete and sign the form and mail it to the address listed. We strongly encourage you to call us at 1-877-452-5898 for assistance in completing the form so your enrollment will not be delayed. You will need Adobe Acrobat Reader to view these documents.

Mail your enrollment form to: 
SCAN Health Plan
Enrollment Department
3800 Kilroy Airport Way, Suite 100
Long Beach, CA 90806

Language
Year
SCAN Plan
Geography
2016 VillageHealth Enrollment Form (HMO SNP) - Los Angeles - Spanish
2016 VillageHealth Enrollment Form (HMO SNP) - Orange - Spanish
2016 VillageHealth Enrollment Form (HMO-POS SNP) - Los Angeles - English
2016 VillageHealth Enrollment Form (HMO-POS SNP) - Orange - English
2016 VillageHealth Enrollment Form (HMO-POS SNP) - Riverside - English
2016 VillageHealth Enrollment Form (HMO-POS SNP) - Riverside - Spanish
2016 VillageHealth Enrollment Form (HMO-POS SNP) - San Bernardino - English
2016 VillageHealth Enrollment Form (HMO-POS SNP) - San Bernardino - Spanish
2016 California Enrollment Form - Los Angeles - English
2016 California Enrollment Form - Los Angeles - Spanish
2016 California Enrollment Form - Marin - English
2016 California Enrollment Form - Marin - Spanish
2016 California Enrollment Form - Napa - English
2016 California Enrollment Form - Napa -Spanish
2016 California Enrollment Form - Orange - English
2016 California Enrollment Form - Orange - Spanish
2016 California Enrollment Form - Riverside - English
2016 California Enrollment Form - Riverside - Spanish
2016 California Enrollment Form - San Bernardino - English
2016 California Enrollment Form - San Bernardino - Spanish
2016 California Enrollment Form - San Diego - English
2016 California Enrollment Form - San Diego -Spanish
2016 California Enrollment Form - San Francisco - Chinese
2016 California Enrollment Form - San Francisco - English
2016 California Enrollment Form - San Francisco - Spanish
2016 California Enrollment Form - San Joaquin - English
2016 California Enrollment Form - San Joaquin - Spanish
2016 California Enrollment Form - Santa Clara - English
2016 California Enrollment Form - Santa Clara - Spanish
2016 California Enrollment Form - Sonoma - English
2016 California Enrollment Form - Sonoma - Spanish
2016 California Enrollment Form - Ventura - English
2016 California Enrollment Form - Ventura - Spanish

Disclaimer

Heart First is available to anyone who has been diagnosed with Chronic or Congestive Heart Failure and/or Cardiovascular Disorders.

SCAN Balance is available to anyone who has been diagnosed with Diabetes.

SCAN Connections and SCAN Connections at Home are available to anyone who has both Medical Assistance from the State (Medicaid/Medi-Cal) and Medicare.

Medicare beneficiaries may also enroll in SCAN Health Plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.