2023 Plan Materials and Resources

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

2023 Extra Help Premium Summary Table

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

Part D Coverage Re-Determination Form

2023 Medicare Star Ratings

MedImpact Forms

MedImpact Direct Referral Form

MID Mail Order Form

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