Plan Materials and Resources
Member Materials
| 2021 Annual Notice of Changes (ANOC) | English Español 中文 |
 |
|---|---|---|
| 2021 Summary of Benefits | English Español 中文Русский | |
| 2021 Evidence of Coverage | English Español | |
| 2021 Provider and Pharmacy Directory | |
|
| 2021 Formulary | English Español 中文 | |
| 2021 Extra Help Premium Summary Table | English Español 中文 | |
| Language Assistance | English Español 中文 Creole Русский Italiano 한국 | |
| Enrollment Form | English Español 中文Русский | |
| 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 Español 中文 | |
| 2021 Medicare Star Ratings | English Español 中文 Русский | |
Member Resources
| *By clicking these links, you will be leaving VillageCareMAX website.
New York Medicaid Choice – Enrollment Broker CMS Best Available Evidence Policy Submit a complaint to Medicare 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 |
|---|
H2168_MKT21-19_M 09272020
This page was last modified on October 22, 2020
This page was last modified on October 22, 2020
1.800.469.6292