Enrollment and Renewal

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Disclaimer -

This is a solicitation for insurance and an agent may contact you.

By submitting my information via this form, I consent to having Molina Healthcare collect my personal information. I understand and agree that my information will be used and shared in accordance with Molina Healthcare's Privacy Policy and Terms of Use.

Enroll today!

When you join Senior Whole Health Medicare, you can be sure your individual needs are met.

Please follow the instructions and complete the Enrollment Form, today. We encourage you to read the Summary of Benefits before completing an Individual Enrollment Request form.

 


Enroll online

2023 Online Enrollment Form

 

 

 



Enroll by mail

icon PDF 2023 Enrollment Form

     Senior Whole Health by Molina Healthcare, Inc.
        Attn: Membership Accounting
         PO BOX 22800
        Long Beach, CA 90801-9945

 





If you need help completing this enrollment form or have questions about plan benefits prior to enrollment, please call us Toll Free: (866) 403-8293, TTY/TDD: 711, Monday to Saturday, 8:00 a.m. to 8:00 p.m. local time. Senior Whole Health determines when your Enrollment Form is complete based on Medicare enrollment guidelines. The Enrollment is subject to approval from the Centers for Medicare & Medicaid Services (CMS). If your enrollment is not accepted by CMS, we will notify you immediately.

CMS Medicare Online Enrollment Center

Medicare beneficiaries may also enroll in the Senior Whole Health plans through the CMS Medicare Online Enrollment Center located at www.medicare.gov.