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Expansion Counties Effective 1/1/2023:

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Nassau: (pending)

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2023 Formulary

Multi-Language Insert

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2023 Plan Materials and Resources

Plan Materials

2023 Annual Notice of Changes (ANOC)

2023 Summary of Benefits

2023 Evidence of Coverage

2023 Addendum to ANOC, Summary of Benefits and Evidence of Coverage

2023 Provider and Pharmacy Directory

2023 Formulary

Multi-Language Insert

Language Assistance and Notice of Non-Discrimination (LANN)

Prescription Drug Claim Form

Appointment of Representative Form

Health Care Proxy Form & Information

Part D Coverage Determination Form

Member Reimbursement Form

Prescription Drug Mail Order Form

Privacy Notice

Enrollment Form

2023 Medicare Star Ratings

2023 Extra Help Premium Summary Table

MedImpact Forms

Plan Resources

Member Resources

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