St. Als Health Plan Enrollment Link & Instructions

Please click on this link to enroll. It will open in another tab, so you will be able to toggle back and forth between the enrollment page and the step-by-step instructions below. NOTE: only boxes on the application followed by instructions with a red asterisk are required to be filled in.

Put in your zip code and click VIEW PLANS

• Click the purple ENROLL button for the plan you want
• Click CONTINUE TO APPLY
• Enter your demographic info 
• NOTE: When entering your name, it must match exactly as it appear on your Medicare card, including middle initial. If you are a Sr. or Jr., please be sure to include it on the application.
• NOTE: Counties must be written out fully - not abbreviated
• When done, click CONTINUE at the bottom of the page

• Enter your MBI (Medicare number) from your red/white/blue card (all 0s are zeroes)
• Choose the REQUESTED EFFECTIVE DATE of Jan 1, 2026
• Under SELECT A REASON FOR ENROLLING, scroll down to You lose or have a change to your current coverage. Click on the down-arrow you see to the right and a few options will show up under that. Click to put a checkmark in the box to the left of I lost my coverage because my plan no longer covers the area that I live or it ended its contract with Medicare. (NOTE: there may be more than 1 reason that applies to you, but only choose this one. AEP is NOT an option as of Dec. 8) 
• Click CONTINUE at the bottom of the page

Answer the Prescription Drug Coverage, Medicaid Enrollment, and Long Term Care question, as they are required. Then scroll down to PHYSICIAN SELECTION. 

• Type in the name of your Primary Care Physician. (If you don't have one or can't remember, you can click on the FIND A PHYSICIAN button and select one near you. You can always change this at a later date. DO NOT close this enrollment tab in order to find a physician. This will open up another tab where you will be able to search for a physician within the St. Als network. When you find one, click back on the enrollment tab to enter the name and proceed with enrollment.  
• Primary Care Physician NPI is not required. Please leave it blank. 
• Click CONTINUE at the bottom of the page

This plan has no premium, so it does not matter what you choose.

• Complete this section and sign with the mouse or type your signature
• Click CONTINUE

• Check the box next to "I understand..." 
• Check the box next to your relationship to the enrollee. (If enrolling for yourself, mark "I am the person enrolling".)
• Either type in a signature by checking the “Due to physical limitations” box, or sign with your mouse 
• Click CONTINUE

• Review everything you just filled out 
• Once all looks good, click SUBMIT 

1. You will be taken to a page that says Your application has been submitted and is

pending approval. 

• Check your email in-box or junk mail for one from Mt. Carmel (parent company to Saint Alphonsus) that says Your application has been submitted and is pending approval. This is your Guarantee Issue info, so keep this email until you get your cards in the mail. 

2. You are done and may close all tabs. 

3. You will be getting a call from an Aaron Flake associate within the next 7 days asking to complete a Health Risk Assessment with you.  It does not affect your enrollment in any way, but is something St. Als is asking us to do.