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DOB

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Tobacco Use

Yes

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If underwritten, please provide medical history and medications below:

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Medication

Open Enrollment/ Guaranteed Issue

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Fully Underwritten

Yes

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Seniors Advisory Services
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

3636 S. Sherwood Forest Blvd., Suite 370
Baton Rouge, LA 70816

timnic@bellsouth.net
1-833-952-3399
225-295-1079