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Spouse Information

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You can receive an information packet by calling 1-800-808-3239.
You may also request a free information kit by clicking here.

Rate Quote

TEAMStar offers Medicare eligible retirees affordable Retiree Health coverages. The premium rates for {{applicant.StateCode}} are displayed below.

Applicant rates not found

Even though rates are shown, you will not be eligible to apply for {{ratequote[0].DaysLeftIneligible}} days.

{{applicant.Firstname + " " + applicant.LastName}}

 

Spouse rates not found

Even though rates are shown, you will not be eligible to apply for {{ratequote[1].DaysLeftIneligible}} days.

{{spouse.FirstName + " " + spouse.LastName}}

 

SAVE $2 PER PAYMENT BY SELECTING MONTHLY BANK DRAFT

Applicant must have applicable rates in order to proceed.
Please verify the applicant birthdate.


Depending on the plan you select, coverages pay various Medicare deductibles, coinsurances and medical/doctor expenses not covered by Medicare. See the Summary of Benefits for more details.

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Primary Applicant Information

Name: {{applicant.Firstname + " " + applicant.LastName}}
Address: {{applicant.Addr1 + " " + applicant.Addr2}}
City/State/Zip: {{applicant.City + ", " + applicant.StateCode + " " + applicant.Zipcode}}
Date of Birth: {{applicant.DOB | date:'MM/dd/yyyy'}}

Selected Rate Quote

Plan Selection: {{applicant.PlanDesc}}
Rate Selection: {{applicant.Premium | currency: "$":2}}
Payment Frequency: {{applicant.PayMethodDisplay}}

Health Questions

TO THE BEST OF YOUR KNOWLEDGE:
Questions 7-12 not required for applicants who are within 6 months of their enrollment in Medicare Part B. IF THE ANSWER TO ANY OF THE FOLLOWING QUESTIONS IS "YES", THE INDIVIDUAL WHO GIVES THE "YES" ANSWER IS NOT ELIGIBLE FOR COVERAGE.

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Yes No Yes No
  • {{questionpart.QuestionPartText}} {{questionpart.QuestionPartText}} {{questionpart.QuestionPartText}}
    {{questionpart.QuestionPartText}}
    Yes No
    {{questionpart.QuestionPartText}}

Spouse Information

Name: {{spouse.FirstName + " " + spouse.LastName}}
Date of Birth: {{spouse.DOB | date:'MM/dd/yyyy'}}

Selected Rate Quote

Plan Selection: {{spouse.PlanDesc}}
Rate Selection: {{spouse.Premium | currency: "$":2}}
Payment Frequency: {{spouse.PayMethodDisplay}}

Health Questions

TO THE BEST OF YOUR KNOWLEDGE:
Questions 7-12 not required for applicants who are within 6 months of their enrollment in Medicare Part B. IF THE ANSWER TO ANY OF THE FOLLOWING QUESTIONS IS "YES", THE INDIVIDUAL WHO GIVES THE "YES" ANSWER IS NOT ELIGIBLE FOR COVERAGE.

{{question.QuestionOrder}}. {{question.QuestionText}} *

Yes No Yes No
  • {{questionpart.QuestionPartText}} {{questionpart.QuestionPartText}} {{questionpart.QuestionPartText}}
    {{questionpart.QuestionPartText}}
    Yes No
    {{questionpart.QuestionPartText}}
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