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.
- Annual Notice of Change
- Benefit Highlights
- Claims and Reimbursement Request Forms
- Enrollment Forms
- Evidence of Coverage Documents
- Explanation of Benefits
- Formulary Documents
- Grievance & Appeals
- Low Income Subsidy Premium Summary Charts
- Medicare Part B Prescription Drug Costs Documents
- Over-the-Counter Benefit Catalogs
- Part C Organizational Determination Process
- Provider and Pharmacy Directory
- Rights and Responsibilities Upon Disenrollment
- STAR Ratings
- Summary of Benefits
