2027 Plan Materials and Resources

Plan Materials

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2027 Annual Notice of Changes (ANOC)

2027 Summary of Benefits

2027 Evidence of Coverage

2027 Formulary

2027 Extra Help Premium Summary Table

Notice of Availability

Language Assistance Notice

Prescription Drug Claim Form

Appointment of Representative Form

Health Care Proxy Form & Information

Part D Coverage Determination Form

Part D Coverage Re-Determination Form

Member Reimbursement Form

Privacy Notice

Enrollment Form

2027 Medicare Star Ratings

eSign Online Forms

Appointment of Representative Form

Health Care Proxy Form

Member Reimbursement Form

Consumer Directed Personal Assistance Program (CDPAP) Form

MedImpact Forms

MedImpact Direct Referral Form

MID Mail Order Form English (updated 9/2026)

MID Mail Order Form Spanish (updated 9/2026)

MID Mail Order Form Chinese (updated 9/2026)

Plan Resources

Member Resources

New York Medicaid Choice – Enrollment Broker

CMS Best Available Evidence Policy

Submit a complaint to Medicare

Medicare Ombudsman Office