AEP 2024 form instructions

Welcome to the 2024 Annual Enrollment Period! If you are using this form, you have elected to send me your information for me to review. If I find that your current plan would serve you just as well as any 2024 plan, we do not need to meet. If I find that your current plan should be replaced, I will contact you to schedule a call.

You have until 12/7/2023 to make a change, so there is plenty of time to go through this process.

NOTE: Please fill out one copy of this form PER PERSON.

Each medication should be added with all the relevant information, one at a time. If you have additional prescriptions to enter, click the “Add Another Prescription” button to add the next one. Repeat until you’ve entered all of your prescriptions.

You and I will both receive an email notification after you click Submit at the bottom.