Enroll a Member
Keystone First VIP Choice strives to make the member enrollment process as easy as possible. As a reminder, you're required to provide a pre-enrollment checklist (PDF), summary of benefits (PDF), multi-language insert (PDF), and non-discrimination notice (PDF) any time you provide an enrollment request to a beneficiary.
When filling out the enrollment application, make sure that the correct information is in the following sections:
- NIPR number.
- Agent broker ID — Use your insurance license number.
- Agent writing number — Use your Rep ID number.
Use the individual enrollment request form and fax cover sheet, found below, to send your enrollment applications, along with the scope of appointment confirmation form. Fax each application one at a time to 1-855-822-9400.
Keystone First VIP Choice enrollment forms
- 2020 Individual enrollment request form (PDF)
- 2020 Fax cover sheet (PDF)
- 2020 Scope of appointment confirmation form (PDF)