Plan Materials
2022 Annual Notice of Changes (ANOC)
2022 Summary of Benefits
2022 Evidence of Coverage
2022 Provider and Pharmacy Directory
Bronx: Brooklyn: Manhattan: Queens:2022 Formulary
Language Assistance
Enrollment Form
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
Notice of Non-Discrimination
Part D Coverage Re-Determination Form
2022 Medicare Star Ratings
2022 Extra Help Premium Summary Table
Plan Resources
Member Resources
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