2022 Plan Materials and Resources

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

2022 Extra Help Premium Summary Table

Prescription Drug Claim Form

Appointment of Representative Form

Part D Coverage Determination Form

Member Reimbursement Form

Prescription Drug Mail Order Form

Privacy Notice

Part D Coverage Re-Determination Form

2022 Medicare Star Ratings


Plan Resources

Member Resources

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New York Medicaid Choice – Enrollment Broker

CMS Best Available Evidence Policy

Submit a complaint to Medicare

Medicaid Ombudsman Office

The State of New York has created an ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide members with free, confidential assistance on any services offered by VillageCareMAX Medicare Total Advantage Plan. ICAN may be reached toll-free at 1-844-614-8800 or online at icannys.org

Medicare Ombudsman Office

Page Last Updated: 10/19/2021