MEDICARE PRESCRIPTION DRUG PLAN (PDP) INDIVIDUAL 2026

1. Click ‘Get Form’ to open the MEDICARE PRESCRIPTION DRUG PLAN (PDP) INDIVIDUAL enrollment form in our editor.
2. In Part A, enter your requested effective date and provide your personal information, including your name, NDPERS Member ID, last four digits of your Social Security number, and date of birth.
3. Proceed to Part B to fill in any retired member information if applicable. Ensure all details are accurate for a smooth enrollment process.
4. In Part C, provide your permanent residence address and telephone number. Make sure to include the street address, city, state, and zip code.
5. For Part D, retrieve your Medicare card and fill in the required Medicare insurance information. Attach a copy of your Medicare card or relevant documentation as instructed.
6. Finally, review all sections for accuracy before signing at the bottom of the form. Remember that this form cannot be submitted more than 90 days prior to the requested effective date.

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