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Policy Change Request

The following form is provided to you for making changes or requests on your existing policies. By submitting this form you understand that no coverage or premium adjustment of any kind is bound until you receive written notice from us.

Policy Change Request

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General Information

Current Insurance Information

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Medicare Scope of Appointment

To initiate a conversation regarding Medicare plans, please complete and submit the Medicare Scope of Appointment form, as mandated by current U.S. law. We sincerely appreciate your cooperation.

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My wife and I met with Shari today and we both can't say enough nice things...

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Shari helped us navigate the very confusing Medicare and Health Insurance...

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So happy we called Shari. She helped make our process so much easier and gave...

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I knew Nothing about the Medicare process, and it looked daunting. Called...

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I give Shari a 5 star review. She walked me through the process of enrolling in...

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Daunted by the process of enrolling in Medicare coverage, I relied on the...

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