Form CMS-10718 Enrollment Form
Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)
CY 2025 revised - Model MA PDP Indiv Enrollment Request Form (clean)
Eligibility and Enrollment Eligibility and enrollment (Part D sponsor)
OMB: 0938-1378
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1378 can be found here:
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