Plan Materials and Resources

Member Materials

 

2021 Annual Notice of Changes (ANOC) English Español 中文
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2021 Summary of Benefits English Español 中文Русский pdf icon
2021 Evidence of Coverage English Español pdf icon
2021 Provider and Pharmacy Directory  

Bronx:  English Español 中文 

Brooklyn:  English Español 中文

Manhattan: English Español 中文

Queens: English Español 中文

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2021 Formulary English Español 中文 pdf icon
2021 Extra Help Premium Summary Table English Español 中文 pdf icon
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 pdf icon
Part D Coverage Determination Form English pdf icon
Member Reimbursement Form English (coming soon) pdf icon
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 pdf icon
2021 Medicare Star Ratings English Español 中文 Русский