Advantage by Managed Health Services HMO SNP (Advantage by MHS)

Step 1: Please fill out all 6 pages of the application completely.Step 2: Sign and date the last page of the application.Step 3: Please make a copy of the application for your records.Step 4: Mail the original copy to Advantage by MHS. You can call the plan to request a pre-paid envelope (no stamp needed).

(Please note: By clicking on this link you will be leaving the Advantage by MHS website.) Enrollment Form 2012 (.pdf) If you have any questions regarding this application, please contact Member Services at (888) 713-6180, or TTY (800) 466-6136, 8am- 8pm, 7 days a week, and ask to speak with a Sales Representative. Advantage by MHS:  10700 W. Research Drive, Suite 300, Milwaukee, WI 53226 By asking to speak with a sales agent, you will be directed to a licensed insurance agent/broker. You are not required to speak with a sales agent. You can speak with a Member Service Representative to receive plan information. Notice of Possible Contract Termination Disclaimer: By law Advantage by MHS can choose to not renew our contract with the Centers for Medicare & Medicaid Services (CMS). CMS may also refuse to renew the contract, thus resulting in a termination or non-renewal. If either of these scenarios occur, this may result in termination of beneficiary enrollment in the plan. In addition, MHS may reduce its service area and no longer offer services in the area where a beneficiary resides.