Plan Materials
Here’s where you’ll find our most up-to-date information on health plan benefits, printable provider directories, claims and enrollment forms, and more.
Please note: You may need to install Adobe Acrobat Reader to view these documents on your desktop computer. You can get it here.
Call Member Services at 1-800-559-3500 for additional information. (TTY Users: 711). Hours are 8 a.m. to 8 p.m., seven days a week from October 1 to February 14.
From February 15 to September 30 hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day.
From February 15 to September 30 hours are 8 a.m. to 8 p.m. Monday through Friday. Messages received on holidays and outside of our business hours will be returned within one business day.
- Annual Notice of Change
- Evidence of Coverage Documents
- Formulary Documents
- Benefit Highlights
- Summary of Benefits
- Claims and Reimbursement Request Forms
- Enrollment Forms
- Grievance & Appeals
- Low Income Subsidy Premium Summary Charts
- Pharmacy Directory Introductions
- Provider and Pharmacy Directory
- Rights and Responsibilities Upon Disenrollment
- STAR Ratings
