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Proposal Request for Medicare

Please contact your Kistler Tiffany Benefits consultant with any questions.

Please fill out the following information entirely.
Client Name

Street Address

City

Zip
State

Phone
Email ( if available)
County of Residence
Date of Birth:
(not Age, but Date of Birth)

Medicare Part A

 Yes No

Medicare Part B

 Yes No

Current Status Retired
Losing Current Coverage: No

If Yes, please list reason:

  


Current Coverage:

If you selected "other" please name your policy.

Current Drug coverage under Medicare Part D: No
List of drugs with exact name, dosage and frequency

Brief description of request or question from client


 




Customer Services


Let Kistler Tiffany Benefits
give your group the edge in
employee benefits planning
customer

As an employer, you are under considerable pressure to provide employee benefits at a reasonable cost. The task of shopping, designing, implementing, and administering benefit plans is complex. That's why you and your employees will benefit from the expertise of Kistler Tiffany Benefits consultants. We provide customized benefit solutions for your employee benefit needs as well as a wide rage of popular voluntary coverages.

Whether you wish to offer employer-paid, employee-paid, or shared contribution programs, Kistler Tiffany Benefits can develop winning strategies for you. Thanks to the volume of business we place and the number of carriers we have relationships with, we are able to provide bids from highly rated companies, many of which are well known to you and some that are new to the Philadelphia regional marketplace. We have direct contact with senior management at several well-known insurers, enabling us to directly negotiate for you. Some major insurers even have representatives dedicated to serving only our accounts.