Useful Links

Summary of Benefits
 

Multi-Language Interpreter Services

Do you need plan information in a different format?
 

Current Annual Notice of Change/Evidence of Coverage
 

Current Provider Directory

If you would like a copy of the provider directory mailed to you please call customer service at 1-800-329-2792, TTY 711. We are available Oct. 1 - Feb. 14, 8 a.m. to 8 p.m., 7 days a week, Feb. 15 - Sept. 30, 8 a.m. - 8 p.m., Mon. - Fri.

 

Privacy Notice under the HIPAA Privacy Rule
 

Current Medicare Star Ratings
 

Current List of Covered Drugs (Formulary)
 

Utilization Management Documents

Documents include Step Therapy Guidelines, Medication Therapy Management, Prior Authorization Requirements and more.
 

Prescription Drug Transition Policy
 

Extra Help from Medicare (low-income subsidy Premium Summary Chart)

You might qualify to get help in paying for your drugs.
 

Request for Coverage Determination/Redetermination Forms
 

Exception and Appeal Forms

Understand the process for coverage decisions, how to request an appeal, and who to contact with questions related to benefits and coverage for medical services and prescription drugs. 
 

CMS Appoint a Representative Form

You can appoint a representative – like a family member, friend, advocate, attorney, doctor or someone else – to act on your behalf.