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ODS Advantage PPO Individual Enrollment Election Form

ODS Advantage PPO Individual Enrollment Election Form 2025

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The document is an enrollment form for the ODS Advantage PPO, a Medicare Advantage plan offered by ODS Health Plan, Inc. It provides detailed instructions for individuals wishing to enroll, including personal information requirements, plan options with associated premiums, payment methods, and eligibility criteria. The form also includes important disclosures regarding the impact of enrolling on existing health coverage and outlines the process for providing necessary Medicare information.

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