Member to Member

Complete la solicitud en línea de forma segura y siguiendo unos simples pasos. Comience con su n.° de identificación de miembro de Elderplan o HomeFirst. Es el número que aparece junto al n.° de identificación de miembro en su tarjeta de beneficios de Elderplan. Luego le haremos preguntas sobre usted y sus intereses.

    Contact Information

    Thank you for your interest in Elderplan's Member to Member Program, we are excited to have you join us!

    To help us better understand your needs, please provide the following demographic information.
    Your responses will be kept confidential.

    How should we contact you?

    Please select how best we can communicate with you.

    What is your preferred time to receive calls?

    Would you like to receive text messages?

    Activities and Events

    Are there any special considerations we should know about you that will help us in developing our program?

    Select as many as you like

    We are currently offering the following IN-PERSON services and activities:

    We are currently offering the following VIRTUAL events that you can join from the comfort of your home.

    Select as many as you like

    Do you need any technical assistance from us with logging in to the event?

    What device will you use to join the virtual events?

    About You

    Thank you for your interest in Friendly Chats! Answering these and other questions will help us find the best partner for your chat sessions

    Your Hobbies

    What are your hobbies?

    Select as many as you like

    What kind of pet(s) do you have?

    What kind of music do you listen to?

    Select as many as you like

    Career and Work Status

    What is your current work status?

    What industry were/are you in?

    Future Programming

    Are you interested in any of the following topics?

    Select as many as you like

    How did you hear about the M2M program?

    Signature & Disclaimers

    Please review our disclaimers and sign below.

    Anti-Discrimination Statement


    Elderplan is an HMO plan with Medicare and Medicaid contracts. Enrollment in Elderplan depends on contract renewal. Elderplan, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

    ATTENTION: If you speak a non-English language or require interpretation assistance, language assistance services and appropriate auxiliary aids are available to you free of charge. If you need these services or have questions about our plan, call 1-800-353-3765 (TTY: 711). Elderplan, Inc. cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: Si usted habla en un idioma que no es inglés o requiere asistencia de interpretación, tiene a su disposición servicios de asistencia lingüística y las ayudas auxiliares adecuadas de forma gratuita. Si necesita estos servicios o tiene preguntas sobre nuestro plan, llame al 1-800-353-3765 (TTY: 711). Elderplan, Inc. 遵守適用的聯邦民權法律規定,不因種族、膚色、民族血統、年齡、殘障情況或性別而歧視任何人。請注意:如果您說英語以外的語言或需要口譯協助,我們將免費為您提供語言協助服務和適當的輔助工具。如果您需要這些服務或對我們的計劃有疑問,請致電 1-800-353-3765 (TTY: 711)。

    Disclaimers


    Elderplan is a HIPAA Covered Entity and as such will not share your personal information to any third parties for commercial or non-healthcare related purposes. However, by participating in this program you may choose to share personal information with other members at your discretion. Elderplan has no control over the use and misuse of information shared by you with other members. Elderplan strongly recommends that members do not post, or share private information received from other members on social media platforms.


    For example, if you request pharmacy pick up, Elderplan may share the names of your medication with the volunteer who will help with your pharmacy pickup service.


    Also, if you participate in this program, you may choose to share personal information with other Elderplan members at your discretion. Elderplan has no control over the use or misuse of information shared by you with other members. Elderplan also strongly recommends that members do not post or share private information received from other members on social media platforms.


    Elderplan recommends that you check with your doctor before beginning any new physical activities.


    ¿Cómo me uno a la Comunidad Member-to-Member?

    1. Únase en línea ahora completando nuestra solicitud simple y segura.
    2. Únase por correo electrónico descargando el formulario de solicitud para completarlo y luego enviarlo por correo electrónico a: [email protected].
    3. Únase por teléfono llamando a la línea directa de Member-to-Member al 1-347-254-7700 (TTY: 711), de 9:00 a.m. a 5:00 p.m., de lunes a viernes.
    4. Únase por correo descargando el formulario de solicitud para completarlo y luego enviarlo por correo a:
      MJHS Member-to-Member program
      55 Water Street, 46th Floor, Suite 202
      New York, NY 10041
    Man on laptop

    ¡Únase a nuestra comunidad!

    Complete la solicitud en línea de forma segura y siguiendo unos simples pasos. Comience con su n.° de identificación de miembro de Elderplan o HomeFirst. Es el número que aparece junto al n.° de identificación de miembro en su tarjeta de beneficios de Elderplan. Luego le haremos preguntas sobre usted y sus intereses.

    Image of the Elderplan benefits card with sample ID numbers and participant name

    Lea las Preguntas frecuentes para obtener más información sobre cómo enviar la solicitud.

    Obtenga todos los beneficios de la membresía

    Nuestra comunidad les ofrece a los miembros una oportunidad de conectarse entre ellos y disfrutar de una variedad de eventos y actividades.