Plan Details and Documents

Plan Benefit Materials

Access plan documents including your Annual Notice of Change, Summary of Benefits, and Evidence of Coverage.

 Find a Doctor or Pharmacy

Access Provider and Pharmacy Directories or find a doctor or pharmacy using our search tool.

 List of Drugs (Formulary)

If you have a Medicare Advantage Prescription Drug plan, access your plan’s Drug List (Formulary) and search tool.

 Member Perks

Learn about member perks such as telehealth, dental, and over-the-counter benefits.

 Disaster Coverage

Learn how to access coverage in the event of a disaster or local emergency.

 Appointment of Representative Form

Use this form to appoint a representative on your behalf.

 Prescription Drug Claim Form

If you have a Medicare Advantage Prescription Drug plan, use this form when you need to ask us to pay you back for prescriptions paid out-of-pocket.

 Member Reimbursement Claim Form

Use this form when you need to be reimbursed for eligible out-of-pocket medical expenses.

 Medicare Disenrollment

Use our online disenrollment form to request a disenrollment from the plan.

 Real Time Benefit Tool

To access the Real Time Benefit tool, login to the secure member portal. If you don’t have an account, select “Create New Account” and follow the prompts.