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�������ֳ� has partnered with GoHealth, a marketplace for Medicare plans, to assist employees in finding a plan that best meet their needs.

Contact GoHealth at 866-246-9681 (TTY users 7-1-1) to speak with a licensed agent.

Click the links below for more information and helpful tips:

• What You Need to Know When You Turn 65
• Find Medicare Coverage
• Navigating Medicare

The Request for Employment Information form is used for proof of group health care coverage based on current employment. This information is needed to process your Medicare enrollment application. The employer that provides the group health plan coverage completes the information about your health care coverage and dates of employment.

In order to apply for Medicare in a Special Enrollment Period, you must currently have or previously have had group health plan coverage within the last eight months through your or your spouse's current employment. People with disabilities must have large group health plan coverage based on your, your spouse's, or a family member's current employment.

How to complete the form:

1. Retiree completes the first section of the form.
2. The employer completes the second section and signs at the bottom.

Click the link below to access the form:

Who Can Use this Application?

People who are already enrolled in Medicare Part A can use this application to enroll in Medicare Part B.

When Should I Use this Application?

• If you're in your Initial Enrollment Period (IEP) and live in Puerto Rico, you must use this form to apply for Medicare Part B.
• If you're in your IEP and refused or did not sign up for Medicare Part B when you applied, you can use this form to apply for Part B.
• If you want to sign up for Medicare Part B during the General Enrollment Period (GEP) from January 1 – March 31 each year, you can use this form.
• If you refused Medicare Part B during your IEP because you had group health plan (GHP) coverage through your or your spouse's current employment, you may use this form to apply during your eight-month Special Enrollment Period (SEP).
• If you have Medicare due to disability and refused Part B during your IEP because you had group health plan coverage through your, your spouse's, or your family member's current employment, you can use this form to apply.
• You may use this form to apply for Medicare Part B during your eight-month Special Enrollment Period.

Note: Your IEP lasts for seven months. It begins three months before your 65th birthday (or 25th month of disability) and ends three months after you reach 65 (or three months after your 25th month of disability).

Click the link below to access the form:

Appointed faculty and staff who satisfy all three of the following criteria are eligible to officially receive retiree status from the �������ֳ� Retirees Association and are eligible for benefits:

1. Left employment voluntarily
2. Reached the age of 55 years
3. Been employed in a benefited position continuously for a minimum of 5 years

Eligible appointed faculty and staff receive the following retiree benefits:

1. Opportunity to apply for a membership with the �������ֳ� Retiree Association.
2. Opportunity to receive monthly �������ֳ� Retirees e-blasts and newsletters providing news and updates about �������ֳ� programs, activities, and available resources
3. Opportunity to receive invitations to attend at least three �������ֳ� Retirees social events on a complimentary basis annually
4. Opportunity to receive discounted pricing for attendance at selected Lamont School of Music and/or home athletic events
5. Opportunity to request and receive RTD booklets, subject to availability

To apply for a membership to The �������ֳ� Retirees Association, click the link below. A Retiree Association Chair Member will reach out to confirm membership.

Appointed faculty and staff who satisfy all three of the following criteria are eligible to officially receive retiree status from the �������ֳ� Retirees Association and are eligible for benefits:

1. Left employment voluntarily
2. Reached the age of 55 years
3. Been employed in a benefited position continuously for a minimum of 20 years*

*Faculty members with emeritus status are eligible for retiree benefits regardless of their years of service.

Review the links below for retiree benefits summaries and rates:

• �������ֳ� Retiree Medicare Kaiser Benefits Summary
• Early Retiree Benefits Summary (Cigna & Kaiser)
• Retiree Post 65 Election Form

• Campus Privileges Extended through the Retiree ID Card
• Retiree Tuition Waiver
• Opportunity to apply for membership in the �������ֳ� Retirees Association
• Opportunity to receive monthly �������ֳ� Retirees e-blasts and newsletters providing news and updates about �������ֳ� programs, activities, and available resources
• Opportunity to receive invitations to attend at least three �������ֳ� Retirees social events on a complimentary basis annually
• Opportunity to receive discounted pricing for attendance at selected Lamont School of Music and/or home athletic events
• Opportunity to request and receive RTD booklets, subject to availability

To apply for a membership to The �������ֳ� Retirees Association, click the link below. A Retiree Association Chair Member will reach out to confirm membership.

• �������ֳ� Retiree Tuition Waiver Benefit
• Retiree ID Card Summary

• As a �������ֳ� retiree and member of the the �������ֳ� Retirees Association you are entitled to apply for 1 of 4 stipends that will be awarded each quarter during the academic year (Fall, Winter, Spring).
• You must apply for the stipend prior to the end of the quarter in which you take the class.
• Stipends are granted on a first-come, first-served basis.
• You may be awarded one stipend per quarter.

Eligible classes are those offered by the Osher Lifelong Learning Institute��at �������ֳ�, the College of Professional Studies Enrichment Program at �������ֳ� and the Knoebel Institute for Healthy Aging at �������ֳ�.

• When registering for courses at College of Professional Studies Enrichment Program, use code �������ֳ�RW18 for a 20% discount; some restrictions apply.

Click the links below to for available programs and register for classes. Both online and in-person classes are available.

1. You must complete your application for the stipend (see link below) before the end of the quarter in order to receive a check up to $250 or the cost of the class, whichever is less. A check will be mailed to you after the class has concluded.
2. After completing the Stipend application, please email a copy of your “Proof of payment” receipt to Stephanie.Trujillo@du.edu.
3. After the class has concluded, you will be sent a check/wire up to $250 or the cost of the class, whichever is less.