Paper Application Submissions

You can access and download all enrollment materials by logging into Single Sign-On and selecting Sales Materials Ordering Portal (i.e., CustomPoint).

Visit the CustomPoint Resource Page for more information.

Brokers/Agents have the ability to submit paper applications via fax*. To ensure timely and accurate processing, be sure to submit enrollment applications to the correct health plan fax number. When submitting enrollment applications, be sure to use the appropriate broker identifier.

• Note: Wellcare By Fidelis Care: paper applications submitted should include the Wellcare By Fidelis Care unique broker identifier: FB + NPN (ex. FB123456).

For a full listing of our health plan website addresses and health plan fax numbers, refer to the Medicare Health Plan Reference Guide.

Important Reminders

• Be sure to use the appropriate Application and Scope of Appointment (SOA), determined by the health plan of choice and the effective date/plan year. For example, a 11/1/2024 effective enrollment should be completed on a 2024 application. A 1/1/2025 effective enrollment should be completed on a 2025 application..
• Enrollment applications must be received by Wellcare no later than the calendar day following receipt from the beneficiary.

Print the enrollment receipt for your prospects who prefer a paper copy, or if you will be submitting a paper application to us via fax or mail.

English | Spanish

Applications must be submitted within 48 hours of being completed, and must be submitted along with an enrollment receipt.

• Fax Cover Sheet
• Fax Number: 1-877-264-3859
• Mailing address Devoted Health — Enrollment PO Box 211127 Eagan, MN 55121

1. Paper applications can be submitted to Cigna via fax. When sending your application via fax, please use the follow cover pages:
CignaCoverSheet2025.pdf80.7KB
SpanishCignaCoversheet2025.pdf84.5KB
2. Fax the application to the applicable fax number listed below: › 2025 Applications: 1-877-818-8163 › Arizona HMO 2025 Applications: 1-855-531-9754 › Arizona PPO 2025 Applications: 1-877-818-8163 › Single SOA Forms Only: 1-877-818-9299
3. After your paper application is submitted, you should be able to see it within your broker portal within 2 business days. If you do not see the application please contact Cigna broker support directly.

1. Paper applications can be submitted to Molina via fax. When sending your application via fax, please use the follow cover pages:
MolinaCoverSheet2025.pdf90.8KB
2. All paper Enrollment Forms can be faxed to: (844) 541-6848