CMS-10718 Enrollment Form (Traditional Chinese)
Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)
TChinese_CY 2025- Model MA PDP Indiv Enrollment Request Form_508
Eligibility and Enrollment Eligibility and enrollment (Part D sponsor)
OMB: 0938-1378
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1378 can be found here:
Document [html]
Download:
html
The system is under maintenance. It will be back shortly.