Eligibility and Enrollment


To be eligible for our HMO-POS PLAN Options:

  • Must have Medicare Part A & B
  • Must reside in one of the following counties within Ohio
    • Stark
    • Carroll
    • Columbiana
    • Holmes
    • Harrison
    • Mahoning
    • Medina
    • Portage
    • Summit
    • Trumbull
    • Tuscarawas
    • Wayne
  • Only pre-existing ESRD not eligible to join PrimeTime Health Plan
  • Members may enroll in the plan only during specific times of the year. Contact PrimeTime Health Plan for more information

2018 Enrollment Forms

ENROLLMENT OPTIONS FOR PRIMETIME HEALTH PLAN


ONLINE

Begining October 15, 2017, you can complete a secure online enrollment application by continuing with the green button below.

This is an actual enrollment request. Filling out the form and clicking “Submit My Enrollment” will begin the process to formally enroll you into the PrimeTime Health Plan of your choice.


I am aware that I am Enrolling in the PrimeTime Health Plan Classic (HMO-POS)

$42 Monthly Premium

$0 Annual Deductible

$4,900 Annual Out-of-Pocket Max


By completing this enrollment form, you are sending an actual enrollment election to AultCare's PrimeTime Health Plan.

You will get an enrollment packet in the mail from PrimeTime Health Plan within seven to ten calendar days of enrolling online.

For more information, contact PrimeTime Health Plan on our Contact Us Page.



CONTINUE TO CLASSIC ONLINE ENROLLMENT



IN PERSON

You can visit us during our office hours Monday through Friday from 8:00 a.m. to 4:30 p.m. to drop off your completed enrollment application. Additionally, a PrimeTime Health Plan staff person is available to meet with you to discuss your plan options. You can complete an enrollment application during this appointment or take one with you to fill out and return. To schedule an appointment, please call 330-363-7407 or 1-800-577-5084. TTY users call 330-363-7460 or 1-800-617-7446. Our call center is available Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1 – February 14, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.).

PrimeTime Health Plan
214 Dartmouth Ave SW
Canton, Ohio 44706


Download your PDF Here


BY MAIL

You can also choose to print and complete an enrollment application. When completed, mail the enrollment application to our office at:

PrimeTime Health Plan
214 Dartmouth Ave SW
Canton, Ohio 44706


Download your PDF Here



Return to Plan Descriptions


Medicare beneficiaries may also enroll with PrimeTime Health Plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov


CONTACT INFORMATION

If you have questions or require language assistance, please call Customer Service at 330-363-7407 or 1-800-577-5084. For people who are hearing impaired, please call our TTY line at 330-363-7460 or 1-800-617-7446. Interpreter services are provided free of charge to you. A customer service representative is available to assist you Monday through Friday from 8:00 a.m. to 8:00 p.m. (October 1 – February 14, we are available 7 days a week, 8:00 a.m. to 8:00 p.m.).

Last updated: 10/01/2017