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Search HIPusa.com Powered by Medicare Options Medicare Homepage Benefit Summaries Benefit Comparison Grid Enrollment Instructions and Forms Formulary and Rx Information - (Including how to file an appeal) Health Plan Provider Directories Evidence of Coverage Access Your Member Handbook Medicare Members Personal Health Record New - Mail Order Pharmacy Services Other Links Medicare Pharmacy Directory Privacy Practice Out of Network Coverage Grievance, Exceptions, Coverage Determinations and Appeals Procedures Potential for Contract Termination Appointment of Representative Form and instructions National Coverage Determinations Customer Service Contact Information	Enrollment Instructions and Forms - Requires Adobe Acrobat Reader 2008 To enroll in any of the HIP Medicare products, you must meet the eligibility requirements as described in the Medicare Plan Overview or the plan summary of benefits. Just complete the appropriate form(s), keep a copy for your records and mail them to: HIP Health Plan of New York Attention: Medicare Marketing P.O. Box 2859 New York, NY 10117-7894 Enrollment forms: Since the annual election period ends on March 31, 2008, click here to see if you may have a special election period. For HIP VIP Medicare Advantage Forms (for Medical Plans with/without Part D Drug Coverage, click here: - NYC/Nassau Enrollment form - Suffolk / Westchester Enrollment Form For HIP Medicare Part D Form, click here: - PDP form Additional Instructions: You must complete and return one of the following additional forms to enroll in the HIP VIP Care Improvement Plan or HIP VIP Medicaid Advantage Plan: - HIP VIP Care Improvement Form - HIP VIP Medicaid Advantage Form If you would like to speak to a HIP VIP Marketing Representative, please call 1-800-847-8788. You may also enroll in HIP Plans online at the www.medicare.gov website. H3330_H07_200f u/f 10/07