Enrollment is free and open year-round. Once enrolled, you never need to re-apply.
Applications are available in English and Spanish. You will need Acrobat Reader to view and print the documents.
Complete the application by printing clearly with black or blue ink. Be sure to sign and date the application and include the required documentation listed below.
Send one copy of each of the following documents with your enrollment
form.
Do not send originals.


These copies do not need to be in color.
If you do not include the required documents your application will be returned as incomplete. Please send copies only. DO NOT SEND ORIGINAL DOCUMENTS.
Nothing - the program is free. MoRx does not have an enrollment fee, deductible or monthly premium.
Current MoRx members should not fill out an application. Once you are enrolled in MoRx, you will not need to re-apply again. However, notices may be sent periodically requesting updated information.
If you have a change in address, income, marital status or any other situation that you feel may affect your MoRx eligibility, please call us at 1-800-375-1406. The call is free. Persons with hearing or speech disabilities may call our TTY number toll-free at 1-800-375-1493.
Once we receive and process your completed MoRx application with required documents, we will send you a welcome letter and membership card.
In addition to your Part D plan and MoRx benefits, you may be eligible for extra help with prescription costs from the federal government. To learn more about this extra help, visit www.socialsecurity.gov or call 1-800-772-1213 toll-free.
07/01/09