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We would like to confirm that you agree to have the following products discussed during the appointment: Geisinger Gold Medicare Advantage Plans (MA Plans) and Medicare Advantage plans with prescription drugs (MA-PD Plans), including Medicare HMOs such as Geisinger Gold Classic, PPOs like Geisinger Gold Preferred and PFFS plans or stand-alone Prescription Drug Plans (PDP).

Rest assured: You will not be asked for any information other than your name, address and phone number. Your agreement to discuss the aforementioned plans does not affect your current coverage and will not enroll you in one of our plans.

Asterisk denotes a required field
Do you agree to meet with a sales representative to discuss Medicare Advantage (MA) plans?
Do you agree to discuss Medicare Advantage plans with prescription drug coverage (MA-PD plans)?
Do you agree to speak about stand-alone Prescription Drug plans (PDP)?
You did not agree to discuss plans with a sales representative. Please note that you will be contacted prior to your scheduled visit regarding this.

Y0032_18270_1_M File and Use 10/1/18