Request an Information Kit

Complete the form below to get an information kit for . Please allow 7 to 15 business days for delivery.

All fields marked with an asterisk ( * ) are required.

This page requires you to select a plan on the previous step. Return to the plan page and select a plan.

*First Name

*Last Name

*Home Address (enter the permanent address of the applicant)

*City

*State

*ZIP Code

By giving us your email address or telephone number, you agree to allow us to contact you. We'll give you details about our health plans, services and/or educational information related to health care.

If you enter your phone number, we'll call you in a few weeks during regular business hours. The reason for the call is to see if you have any questions or need help selecting a plan.

Phone Number

Re-enter Phone Number

Email Address

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Do you want the information sent to another person or address?

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*First Name of Recipient

*Last Name of Recipient

*Address of Recipient

*City

*State

*ZIP code

Let us help you

Email us or call a Coventry representative at (TTY: 711), Monday - Friday, 8 a.m. to 8 p.m.

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Disclaimers

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

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