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Online Document Delivery Agreement (agreement to go paperless)

Thank you for choosing to receive your Medicare Late Enrollment Penalty information online. The Medicare Late Enrollment Penalty includes the following list of documents.

  • Confirm Adjustment of Premium Upon LEP Reconsideration
  • Creditable Coverage Info Received after Deadline
  • Late Enrollment Penalty (LEP) Attestation - Final
  • Late Enrollment Penalty (LEP) Attestation - Group Level - Final
  • Late Enrollment Penalty (LEP) Attestation - Group Level - Initial
  • Late Enrollment Penalty (LEP) Attestation - Member Level - Initial
  • Late Enrollment Penalty Annual Change
  • Late Enrollment Penalty- LEP Adj due to Untimely Attestation
  • LEP Adjustment Due to Plan Error
  • Notice of Late Enrollment Penalty (LEP)
  • Notice of LEP Adjustment Reported
  • Removal of LEP Due to Part D Low Income Subsidy
  • Removal of LEP Due to Subsequent Initial Enrollment Period
  • Return of Creditable Coverage Info without an Enroll Request

Viewing your Medicare Late Enrollment Penalty documents online, instead of receiving printed materials by mail, is environmentally friendlier and secure.

Your preference selection tells us how you would like to receive your documents during our normal distribution process. Your preference to receive electronic documents online will be processed within 30 days of your request.

Your electronic Medicare Late Enrollment Penalty documents will be posted in a format that you can easily open, view, and print using industry standard software at any time.

If you change your mind, you may come back to this site to update your preference at any time. Simply opt back in to the paper process by choosing "By mail & online". Your preference will be processed within 30 days of your request and your Medicare Late Enrollment Penalty will be mailed in the next Medicare Late Enrollment Penalty cycle.

If you would like to request a paper copy, have any questions about your Medicare Late Enrollment Penalty, or need help with the online feature, please call Member Services.