Iron Road

Online Medicare Application

Processing your application...

Welcome!

This process takes you through a series of questions and information to enroll you in our Medicare Plan.
We will need to collect information to pay for your first month of insurance via ACH bank draft or credit card. We won't charge you for that until we've reviewed and accepted this application.

Let's get started!

Are you currently covered by Iron Road Healthcare?

If you answer "Yes", we will prompt you to login. This allows us to pre-fill this application with your information.

Have you or your spouse worked for Union Pacific Railroad or any of its affiliates?

(Denver Rio Grande, Western Pacific, Southern Pacific, Missouri Pacific,
MKT (Missouri, Kansas, Texas Lines), Chicago or Northwestern)

We are unable to offer you coverage

Please contact customer service at 1-800-547-0421

Is this application for an employee or a spouse of an employee?

Are you becoming eligible for medicare?

Are you over the age of 65 and retiring from employment with group healthcare coverage?

(Proof of prior credible coverage may be required)

Iron Road will not be holding a Medicare Open Enrollment period this year.

You may still apply if you qualify for a Special Enrollment Period (SEP), such as:

Turning 65 or first becoming eligible for Medicare
Retiring and losing employer group health coverage
Other qualifying life events defined by Medicare

If you believe you qualify for a Special Enrollment Period, please restart the application and continue answering the questions.

For details on qualifying events, visit Welcome to Medicare

First name: *

Last name: *

Middle initial:

Mailing Address (that is on file with the RRB): *

Apartment, Suite, Other:

City: *

State: *

ZIP: *

Preferred phone: *

Email address:*

Gender: *

Iron Road Member ID number:

Date of birth: *

If, in the last 90 days, you have been actively working or went on a Medical Leave, please provide us with the last day you worked (or will work) and the date you applied for your railroad pension.

Date you last worked:

Date applied for railroad pension:

Medicare Information

Medicare number: *

Medicare enrollment starts in: *

Part A date: *

Do you have an Advanced Directive

Yes No

Part B date: *

Do you have other health coverage?

Yes No

Other Health Coverage Company name:*

Other Health Coverage Effective Date: *

ACH Banking Information

Please enter your banking information.

Name on the Bank Account: *

Checking or savings?: *

Routing number: *

Account number: *

Enroll in auto pay? *

Yes No

Confirm Account number: *

As a member enrolled in our Automatic Payment system with ACH auto draft,
we will continue to draft your new dues amount as regularly scheduled.

Would you like to pay with an ACH bank draft?

Iron Road Healthcare (IRHC) offers the option of having your premiums (dues) automatically deducted from your bank account on a monthly basis, in advance, and recurring on the second Monday of each preceding month instead of making direct quarterly payments. Your initial payment to start these transactions will be taken at the time we accept your application.

Payment Information

Your first month payment of $ will be drafted from your bank account upon approval of this application.

Payment Information

Your first month payment of $0
will be charged to your credit/debit card upon approval of your application.

There is no surcharge on debit card transactions or for residents of the following states
Connecticut, Massachusetts

Please review and accept the terms and conditions.

I agree to the terms and conditions

Let's get your credit card information

Your payment will be $0
Your card will not be charged until your application is approved.

There is a 2% surcharge ($0.00) on credit card transactions.
There is no surcharge on debit card transactions or for residents of the following states:
Connecticut, Massachusetts

Iron Road is an Employer Group Medicare Advantage Plan administered by United Healthcare and a Part D Prescription plan, administered by OptumRx. I will need to keep my Medicare Part A and B. I can only be in one Medicare plan at a time and I understand that my enrollment in this plan will automatically end my enrollment in another Medicare health plan. Enrollment in this plan is generally for the entire calendar year. Once I enroll, I may leave this plan or make changes only at certain times of the year if an enrollment period is available, or under certain special circumstances. Once I am a member of the Iron Road Medicare plans, I will read the Evidence of Coverage from United Healthcare and OptumRx. I must follow the rules to get coverage with Iron Road’s Medicare plans. I understand that people with Medicare aren’t usually covered under Medicare while out of the country except for limited coverage near the U.S. border.

Release of Information. By joining this Medicare plans, I acknowledge that Iron Road will release my information to Medicare and other plans as is necessary for treatment, payment and health care operations. I also acknowledge that Iron Road will release my information to Medicare, who may release it for research and other purposes which follow all applicable Federal statutes and regulations. The information on this enrollment form is correct to the best of my knowledge.

I understand that if I intentionally provide false information on this form, I will be dis-enrolled from the plan. I understand that beginning on the date the Iron Road Medicare plans coverage begins, I am required to get all of my healthcare via the Iron Road Medicare plans, and I must supply providers with a copy of my Iron Road Medicare plans ID cards.

Iron Road

Online Medicare Application

Processing your application...

Welcome!

This process takes you through a series of questions and information to enroll you in our Medicare Plan.
We will need to collect information to pay for your first month of insurance via ACH bank draft or credit card. We won't charge you for that until we've reviewed and accepted this application.

Let's get started!

Are you currently covered by Iron Road Healthcare?

Have you or your spouse worked for Union Pacific Railroad or any of its affiliates?

We are unable to offer you coverage

Please contact customer service at 1-800-547-0421

Is this application for an employee or a spouse of an employee?

Are you becoming eligible for medicare?

Are you over the age of 65 and retiring from employment with group healthcare coverage?

Iron Road will not be holding a Medicare Open Enrollment period this year.

Medicare Information

Do you have an Advanced Directive

Do you have other health coverage?

ACH Banking Information

Please enter your banking information.

As a member enrolled in our Automatic Payment system with ACH auto draft,
we will continue to draft your new dues amount as regularly scheduled.

Would you like to pay with an ACH bank draft?

Payment Information

Payment Information

Let's get your credit card information

Have questions?

Survey?

Iron Road

Online Medicare Application

Processing your application...

Welcome!

This process takes you through a series of questions and information to enroll you in our Medicare Plan. We will need to collect information to pay for your first month of insurance via ACH bank draft or credit card. We won't charge you for that until we've reviewed and accepted this application.

Let's get started!

Are you currently covered by Iron Road Healthcare?

Have you or your spouse worked for Union Pacific Railroad or any of its affiliates?

We are unable to offer you coverage

Please contact customer service at 1-800-547-0421

Is this application for an employee or a spouse of an employee?

Are you becoming eligible for medicare?

Are you over the age of 65 and retiring from employment with group healthcare coverage?

Iron Road will not be holding a Medicare Open Enrollment period this year.

Medicare Information

Do you have an Advanced Directive

Do you have other health coverage?

ACH Banking Information

Please enter your banking information.

As a member enrolled in our Automatic Payment system with ACH auto draft,we will continue to draft your new dues amount as regularly scheduled.

Would you like to pay with an ACH bank draft?

Payment Information

Payment Information

Let's get your credit card information

Add A Credit Card

Terms and Conditions

Have questions?

Survey?

Session Timeout Warning

This process takes you through a series of questions and information to enroll you in our Medicare Plan.
We will need to collect information to pay for your first month of insurance via ACH bank draft or credit card. We won't charge you for that until we've reviewed and accepted this application.

As a member enrolled in our Automatic Payment system with ACH auto draft,
we will continue to draft your new dues amount as regularly scheduled.