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Enrollment

If you are interested in learning more about Imperial Health Plan of California (HMO) (HMO SNP) please contact our prospective member toll-free line at: 1-800-838-5914.

Want to enroll in Imperial Health Plan, you can do so in one of the following ways:

  1. Enroll over the phone by calling us at 1-800-838-5648 and we will take your enrollment information over the phone
  2. Schedule a face-to-face appointment by calling 1-800-838-5914 and we can schedule an appointment with an employed Sales Representative or Independent Agent.
  3. Download the attached enrollment form and submit via:

Email: Enrollmentunit@imperialhealthplan.com
Mail: Imperial Health Plan of California, Inc.
Attn: Membership Department
PO BOX 60874
Pasadena, CA 91116
Fax: 626-380-9066

  1. Complete online enrollment application via Medicare Online Enrollment Center (OEC) at http://www.medicare.gov . By accessing this link, you acknowledge that you have reviewed the Imperial Health Plan Summary of BenefitsDrug Formulary, and the Provider Search Function that are provided on https://www.imperialhealthplan.com or by calling the Membership Department at 1-800-626-380-9066.

If you detect or suspect FWA, please report it immediately. Your report is confidential and prohibits retaliation against anyone for reporting in good faith a possible violation of the code, law or regulation.

2020 Enrollment Application

If you select PBP 005 Imperial Senior Value (HMO C-SNP), you must complete the SNP Assessment Form below.

Who can join?
To join any of our Plan Benefit Packages, you must meet all of the following requirements:

  • You live in our service area
  • You have both Medicare Part A and Medicare Part B
  • You are a United States Citizen
  • You do not have End-Stage Renal Disease (ESRD), with limited exceptions

To join Imperial Senior Value (C-SNP), you must also have been diagnosed with diabetes, chronic heart failure (CHF), and/or cardiovascular disorders(s).

If you’re enrolled in a Medicare plan or enrolling for the first time, generally you can only enroll, switch plans, or disenroll from a plan during certain times of the year.

ICEP/IEP-D – Is the first time you can sign up for Medicare. You may join Medicare Parts A, B, C and D during this time. If you qualify by age, it starts 3 months before you turn 65, includes your birthday month, and ends 3 months later.

SEP – The timing of your SEP may vary, depending on your qualifying situation. For example:

  • While you have coverage from an employer
  • You move out of the area your current plan serves, OR
  • You enter, leave or live in a nursing home, OR
  • Your plan changes and no longer serves your area, OR
  • You get Extra Help with your Medicare prescription drug costs.

AEP – Runs each year from October 15 to December 7. During this time, Anyone with Medicare Parts A & B can switch to a Part C plan.

  • Anyone with Medicare Parts A & B can switch to a Part C plan.
  • Anyone with Medicare Part C can switch back to Parts A & B.
  • Anyone who has or is signing up for Medicare Parts A or B can join, drop or switch a Part D prescription drug plan.
  • Anyone with Medicare Part C can switch to a new Part C plan.

OEP – The Open Enrollment Period – sometimes called the Annual Election Period– runs each year from October 15 to December 7. During this time,

  • Anyone with Medicare Parts A & B can switch to a Part C plan.
  • Anyone with Medicare Part C can switch back to Parts A & B.
  • Anyone who has or is signing up for Medicare Parts A or B can join, drop or switch a Part D prescription drug plan.
  • Anyone with Medicare Part C can switch to a new Part C plan.

2019 Enrollment Application

If you select PBP 005 Senior Value (HMO C-SNP), you must complete the SNP Assessment Form below.

Who can join?
To join any of our Plan Benefit Packages, you must meet all of the following requirements:

  • You live in our service area
  • You have both Medicare Part A and Medicare Part B
  • You are a United States Citizen
  • You do not have End-Stage Renal Disease (ESRD), with limited exceptions

To join Senior Value (HMO SNP), you must also have been diagnosed with diabetes, chronic heart failure (CHF), and/or cardiovascular disorders(s).

To read PDFs, you will need Adobe Acrobat Reader. You can download here.

Welcome!
To find out more about Imperial Health Plan of California (HMO) - (HMO SNP), including plan benefits, provider lookup or view member materials, click below.
OR
If you would like to access Imperial Health Holdings Medical Group, click below or call direct at (626) 838-5100 or toll-free at (800) 497-5509