2027 Plan Materials and Resources

Plan Materials

Click on the eSign Online Forms button above to sign electronically. Your email address may be required to complete. This method is not available for all forms on this page.

2027 Annual Notice of Changes (ANOC)

2027 Summary of Benefits

2027 Evidence of Coverage

2027 Formulary

2027 Extra Help Premium Summary Table

Electronic Notice

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

Written Consent Form

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)

MAP Social Care Network

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.