Senior Services of North America, Inc.

This agent portal is for Senior Services Of North America contracted independent insurance agents use only. This is not for public distribution or usage. You must follow CMS guidelines and the insurance departments laws and regulations and use the below documents in a legal and compliant manner. Senior Services Of North America is held harmless for unauthorized or inappropriate usage.

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QUOTE FORMS

QUOTE FORMS

LIFE INSURANCE QUOTE FORM

LONG TERM CARE QUOTE FORM

RETIREMENT PLANNING QUOTE FORM

FINAL EXPENSE

FINAL EXPENSE

NY FORESTERS PLANRIGHT APPLICATIONS

FORESTERS QUOTING SOFTWARE

GERBER FULL KIT

DENTAL

DENTAL

AMERITAS DENTAL STATE AVAILABILITY SHEET

AMERITAS DENTAL NEW YORK RATE SHEET

MEDICARE

AGENT DOCUMENTS

MANDATORY APPLICATION COVER SHEET

AEP Client Letter

Agent Seminar Flyer

Client Thank You Letter

Coverage Request Letter

Generic Scope Of Appointment

Medicare Agent Flyer

Plan Availability Sheet

Suitability Questionnaire

Carrier Broker Support Sheet

AETNA

Elite PPO LIS Chart

Premier PPO LIS Chart

Value HMO LIS Chart

Elite PPO - SUMMARY OF BENEFITS - Albany, Columbia, Delaware, Dutchess, Greene, Montgomery, Orange, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Ulster

Premier PPO - SUMMARY OF BENEFITS - Albany, Columbia, Delaware, Dutchess, Greene, Montgomery, Orange, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Ulster

Value HMO - SUMMARY OF BENEFITS - Albany, Columbia, Delaware, Dutchess, Greene, Montgomery, Orange, Putnam, Rensselaer, Saratoga, Schenectady, Sullivan, Ulster

Elite PPO - SUMMARY OF BENEFITS - Bronx, Kings, Nassau, New York, Queens, Richmond, Rockland, Suffolk, Westchester

Premier PPO - SUMMARY OF BENEFITS - Kings, Nassau, New York, Queens, Richmond

Value HMO - SUMMARY OF BENEFITS - Nassau, Suffolk

Value Plan HMO - SUMMARY OF BENEFITS - New York, Queens

Premier PPO - SUMMARY OF BENEFITS - Bronx, Rockland, Westchester

Premier PPO - SUMMARY OF BENEFITS - Suffolk

Value HMO - SUMMARY OF BENEFITS - Bronx, Kings, Richmond

Value HMO - SUMMARY OF BENEFITS - Rockland, Westchester

Elite PPO - SUMMARY OF BENEFITS - Erie, Niagara

Value HMO - SUMMARY OF BENEFITS - Erie, Niagara

Premier PPO - SUMMARY OF BENEFITS - Allegany, Broome, Cayuga, Chemung, Chenango, Clinton, Cortland, Franklin, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, Schuyler, St. Lawrence, Steuben, Tioga, Tompkins

Premier PPO - SUMMARY OF BENEFITS - Erie, Niagara

Value HMO - SUMMARY OF BENEFITS - Allegany, Broome, Cayuga, Chemung, Chenango, Clinton, Cortland, Franklin, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, Schuyler, St. Lawrence, Steuben, Tioga, Tompkins

AFFINITY

2019 Affinity Application

2019 Affinity Medicare Essentials HMO - SUMMARY OF BENEFITS - Nassau, Orange, Rockland and Westchester

2019 Affinity Dual - SUMMARY OF BENEFITS- Bronx, Kings, Nassau, New York, Orange, Queens, Richmond, Rockland, Suffolk and Westchester

2019 Affinity Medicare Essentials NYC HMO - SUMMARY OF BENEFITS - Bronx, Kings, New York, Queens and Richmond

2019 Affinity Scope Of Appointment

AGEWELL

2019 FeelWell DSNP - SUMMARY OF BENEFITS - Bronx, Kings (Brooklyn), Nassau, New York (Manhattan), Queens & Westchester

2019 AgeWell PlanWell - SUMMARY OF BENEFITS - Bronx, Kings (Brooklyn), Nassau, New York (Manhattan), Queens & Westchester

2019 AgeWell LiveWell - SUMMARY OF BENEFITS - Bronx, Kings (Brooklyn), Nassau, New York (Manhattan), Queens & Westchester

2019 AgeWell Scope Of Appointment

2019 AgeWell Application

2019 AgeWell Plan Comparison

Legal Representative Form

BRIGHT HEALTH

2019 Bright Health LIS Chart

2019 Bright Health Scope Of Appointment

2019 Bright Health MAPD - FULL KIT, APPLICATION, SUMMARY OF BENEFITS, FORMULARY

2019 Bright Health DSNP - FULL KIT, APPLICATION, SUMMARY OF BENEFITS, FORMULARY

CVS SILVERSCRIPTS

2019 Application

2019 Scope Of Appointment

2019 CVS Choice Formulary

2019 CVS Allure Formulary

2019 CVS Plus Formulary

2019 CVS Plan Decision Guide

2019 CVS All Plans - SUMMARY OF BENEFITS

EMBLEM

Emblem Scope Of Appointment

2019 Emblem DUAL DSNP Application

2019 Emblem NON-DUAL Application

VIP Rx Saver HMO - SUMMARY OF BENEFITS - Bronx, Westchester

VIP Value HMO - SUMMARY OF BENEFITS - Dutchess, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester

VIP Dual HMO SNP - SUMMARY OF BENEFITS - New York: Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester

VIP Essential HMO - SUMMARY OF BENEFITS - Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester

VIP Go HMO-POS - SUMMARY OF BENEFITS - Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester

VIP Gold HMO - SUMMARY OF BENEFITS - Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester

VIP Gold Plus HMO - SUMMARY OF BENEFITS - Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster and Westchester

Part B Saver HMO - SUMMARY OF BENEFITS - Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk, Sullivan, Ulster, and Westchester

EMPIRE

2019 Empire Scope Of Appointment

MediBlue Plus HMO - SUMMARY OF BENEFITS - Albany, Rensselaer, Saratoga, Schenectady

MediBlue Plus HMO - APPLICATION - Albany, Rensselaer, Saratoga, Schenectady

MediBlue Dual Advantage DSNP - SUMMARY OF BENEFITS - Albany, Rensselaer and Schenectady

MediBlue Plus Dual Advantage DSNP - APPLICATION - Albany, Rensselaer and Schenectady

MediBlue Select And Plus HMO - SUMMARY OF BENEFITS - Rockland, Westchester

MediBlue Select And Plus - APPLICATION - Rockland, Westchester

MediBlue Select HMO - SUMMARY OF BENEFITS - Richmond

MediBlue Select HMO - APPLICATION - Richmond

MediBlue Select And Plus HMO - SUMMARY OF BENEFITS - Queens

MediBlue Select And Plus HMO - APPLICATION - Queens

MediBlue Select And Plus HMO - SUMMARY OF BENEFITS - Nassau

MediBlue Select And Plus - APPLICATION - Nassau

MediBlue Choice HMO-POS - SUMMARY OF BENEFITS

MediBlue Choice HMO-POS - APPLICATION - Nassau

MediBlue Select And Plus HMO - SUMMARY OF BENEFITS - New York County

MediBlue Select And Plus HMO - APPLICATION - New York County

MediBlue Select And Plus - SUMMARY OF BENEFITS - Kings

MediBlue Select And Plus - APPLICATION - Kings

MediBlue Select HMO - SUMMARY OF BENEFITS - Dutchess, Orange, Putnam

Mediblue Select HMO - APPLICATION - Dutchess, Orange, Putnam

MediBlue Select And Plus - SUMMARY OF BENEFITS - Suffolk

MediBlue Select And Plus - APPLICATION - Suffolk

MediBlue Dual Advantage DSNP - SUMMARY OF BENEFITS - Dutchess, Putnam

MediBlue Dual Advantage DSNP - APPLICATION - Dutchess, Putnam

MediBlue Access PPO - SUMMARY OF BENEFITS - Albany, Rensselaer, Saratoga, Schoharie

MediBlue Access PPO - APPLICATION - Albany, Rensselaer, Saratoga, Schoharie

MediBlue Select And Plus HMO - SUMMARY OF BENEFITS - Bronx

MediBlue Select And Plus - APPLICATION - Bronx

Medicare Supplement - APPLICATION

Medicare Supplement - SUMMARY OF BENEFITS

Medicare Supplement - FULL KIT

FIDELIS

2019 Fidelis Scope Of Appointment

The service area for Fidelis Medicare Advantage Without Rx (HMO-POS) Plan 001, for Fidelis Medicare Advantage Flex (HMO-POS) Plan 003 and Fidelis Medicare $0 Premium (HMO) Plan 021 includes: Allegany, Broome, Cattaraugus, Cayuga, Chemung, Chenango, Cortland, Delaware, Erie, Herkimer, Lewis, Niagara, Oneida, Onondaga, Orleans, Oswego, Otsego, Schuyler, Seneca, St. 11 H3328_FC 18030 Accepted Lawrence, Steuben, Tioga, Wyoming, and Yates Counties, NY. You must live in one of these counties to join the plan.

2019 MAPD PLAN COMPARISON

2019 MAPD - FULL KIT - The service area for Fidelis Medicare Advantage Without Rx (HMO-POS) Plan 001, for Fidelis Medicare Advantage Flex (HMO-POS) Plan 003 and Fidelis Medicare $0 Premium (HMO) Plan 021 includes: Allegany, Broome, Cattaraugus, Cayuga, Chemung, Chenango, Cortland, Delaware, Erie, Herkimer, Lewis, Niagara, Oneida, Onondaga, Orleans, Oswego, Otsego, Schuyler, Seneca, St. 11 H3328_FC 18030 Accepted Lawrence, Steuben, Tioga, Wyoming, and Yates Counties, NY. You must live in one of these counties to join the plan.

2019 DUAL DSNP - FULL KIT

2019 DUAL PLAN COMPARISON

GLOBE LIFE NY

Globe Full Application

2019 Globe Life Rates

2019 Globe Life Brochure

2019 Globe Life Summary Of Benefits

Globe Life Definition of Replacement

Globe Life Replacement Cover Form

Globe Life Conditional Receipt

HUMANA

HUMANA SUFFOLK COUNTY ZIP CODE SERVICE AREA:

The following ZIP codes only in Suffolk: 11702, 11703, 11704, 11706, 11707, 11708, 11716, 11717, 11718, 11721, 11722, 11724, 11725, 11729, 11730, 11731, 11735, 11739, 11740, 11743, 11745, 11746, 11747, 11749, 11750, 11751, 11752, 11760, 11768, 11769, 11775, 11782, 11788, 11795, 11796, 11798.

$0 HMO - $60 Part B Giveback - SUMMARY OF BENEFITS- Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk* *The following ZIP codes only in Suffolk: 11702, 11703, 11704, 11706, 11707, 11708, 11716, 11717, 11718, 11721, 11722, 11724, 11725, 11729, 11730, 11731, 11735, 11739, 11740, 11743, 11745, 11746, 11747, 11749, 11750, 11751, 11752, 11760, 11768, 11769, 11775, 11782, 11788, 11795, 11796, 11798.

$0 HMO - SUMMARY OF BENEFITS - Albany, Rensselaer, Saratoga, Schenectady, Warren, Washington

HMO DSNP - SUMMARY OF BENEFITS - Albany, Broome, Chemung, Oneida, Onondaga, Oswego, Rensselaer, Saratoga, Schenectady, Steuben, Tioga, Warren, Washington

HMO DSNP - SUMMARY OF BENEFITS - Bronx, Kings, New York, Queens, Richmond

$199 PPO - SUMMARY OF BENEFITS - Bronx, Kings, Nassau, New York, Queens, Richmond

$95 PPO - SUMMARY OF BENEFITS - Bronx, Kings, Nassau, New York, Queens, Richmond

$67 HMO - SUMMARY OF BENEFITS - Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk* *The following ZIP codes only in Suffolk: 11702, 11703, 11704, 11706, 11707, 11708, 11716, 11717, 11718, 11721, 11722, 11724, 11725, 11729, 11730, 11731, 11735, 11739, 11740, 11743, 11745, 11746, 11747, 11749, 11750, 11751, 11752, 11760, 11768, 11769, 11775, 11782, 11788, 11795, 11796, 11798

$37.40 Preferred PDP - SUMMARY OF BENEFITS - State Of New York

$35.70 Walmart PDP - SUMMARY OF BENEFITS - State Of New York

$29 PPO - SUMMARY OF BENEFITS - Our service area includes the following county/counties in New York: Albany, Cayuga, Columbia, Greene, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Oswego, Rensselaer, Saratoga, Schenectady, Warren, Washington

$27 HMO - SUMMARY OF BENEFITS - Nassau, Suffolk* *The following ZIP codes only in Suffolk: 11702, 11703, 11704, 11706, 11707, 11708, 11716, 11717, 11718, 11721, 11722, 11724, 11725, 11729, 11730, 11731, 11735, 11739, 11740, 11743, 11745, 11746, 11747, 11749, 11750, 11751, 11752, 11760, 11768, 11769, 11775, 11782, 11788, 11795, 11796, 11798

$17 HMO - SUMMARY OF BENEFITS - Albany, Oneida, Onondaga, Oswego, Rensselaer, Saratoga, Schenectady, Warren, Washington