Medicare Medicare

Enrollment and HIPAA Forms

Becoming a member of SelectSaver HMO or SmartSaver RX PDP Value is easy. To enroll in the one of these plans, print off, complete and mail the application to:

HealthNow New York Inc.
PO Box 5204 
Binghamton, NY 13905 

Enrollment is generally for the full calendar year. Please refer to the Beneficiaries' and Plan's Rights and Responsibilities for information about disenrollment.

You may not disenroll or make changes at other times unless you meet certain special exceptions, such as if you move out of the plan's service area, qualify for Medicaid, or qualify for Extra Help with Medicare prescription drug costs.


Enrollment Forms and Information

Medicare beneficiaries may also enroll in SelectSaver HMO-POS or SmartSaver Rx PDP through the CMS Medicare Online Enrollment Center located at:


HIPAA Authorization Forms

In keeping with the HIPAA Privacy Regulations, the following forms should be used when you wish to give us permission to share your protected health information. See the HIPAA Privacy pages of this web site for further instructions.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year.  The Formulary, pharmacy network, and/or provider network may change at any time.  You will receive notice when necessary. You must continue to pay your Medicare Part B Premium.


Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.


HealthNow New York Inc.  is a Medicare Advantage and stand-alone PDP plan with a Medicare contract. Enrollment in HealthNow New York Inc. depends on contract renewal. 


Y0086_MRK1600 Approved 

Content Last Updated January 19, 2016