Benefits Enrollment Appointment Form

The information you provide will inform our comparison. TIP: Pull out your medication bottles and transcribe the full name of the drug(s) into the field(s) below.

HICAP counseling services are provided by trained counselors, registered by the California Department of Aging, who are acting in good faith to provide independent, impartial information about health insurance policies and benefits to clients. Counselors do not sell any type of health care coverage. They do not endorse or recommend any specific plan or policy. Information presented by HICAP volunteers should not be construed to be legal advice, and volunteers are not liable for acts and omissions in providing counseling to recipients of service. Welfare and Institutions Code, Section 9541 (1)(4)