Plan Materials
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2026 Annual Notice of Changes (ANOC)
2026 Summary of Benefits
2026 Evidence of Coverage
2026 Formulary
2026 Extra Help Premium Summary Table
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
2026 Medicare Star Ratings
eSign Online Forms
Appointment of Representative (updated 7/2025)
Health Care Proxy Form & Information English (updated 1/2025)
Member Reimbursement Form (updated 6/2025)
Consumer Directed Personal Assistance Program (CDPAP) Agreement Form With Designated Representative (updated 9/2025)
Consumer Directed Personal Assistance Program (CDPAP) Agreement Form Without Designated Representative (updated 9/2025)
MedImpact Forms
MedImpact Direct Referral Form
MID Mail Order Form English (updated 9/2025)
MID Mail Order Form Spanish (updated 9/2025)
MID Mail Order Form Chinese (updated 9/2025)
Plan Resources
Member Resources
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New York Medicaid Choice – Enrollment Broker
CMS Best Available Evidence Policy
Submit a complaint to Medicare
