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Plan Materials and Resources

Member Materials

2019 Annual Notice of Changes (ANOC) English Español 中文
2019 Summary of Benefits English Español 中文
2019 Evidence of Coverage English Español 中文
2019 Provider and Pharmacy Directory Bronx Brooklyn Manhattan Queens 
2019 Formulary English Español
2019 Extra Help Premium Summary Table English Español 中文
Multi-language Insert English Español 中文 Creole Русский Italiano 한국
Enrollment Form English Español 中文
Prescription Drug Claim Form English
Appointment of Representative Form English Español
Health Care Proxy Form & Information* English Español 中文 Creole Русский Italiano 한국
Part D Coverage Determination Form English
Member Reimbursement Form English (coming soon)
Prescription Drug Mail Order Form English
Privacy Notice English
Notice of Non-Discrimination English Español 中文 Creole Русский Italiano 한국
Part D Coverage Re-Determination Form English (coming soon)
2019 Medicare Star Ratings English Español 中文
Member Resources
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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

Medicare Ombudsman Office

H2168_MKT19-06_M File & Use 09262018
This page was last modified on February 7, 2019
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