2023 Plan Materials and Resources

Plan Materials

2023 Annual Notice of Changes (ANOC)

2023 Summary of Benefits

2023 Evidence of Coverage

2023 Provider and Pharmacy Directory

Expansion Counties Effective 1/1/2023:

Staten Island: (pending)

Nassau:  (pending)

Westchester:  (pending)

2023 Formulary

Appointment of Representative Form

Part D Coverage Determination Form

Member Reimbursement Form

Prescription Drug Mail Order Form

Privacy Notice

2023 Medicare Star Ratings

2023 Extra Help Premium Summary Table

Plan Resources

Member Resources

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Page Last Updated: 11/28/2022