These documents give you information about how our Medicare Advantage plan works.
They explain what’s covered, what you pay, and how to get coverage for the health care services and prescription drugs you need.
2022 Benefit Year
General Plan Documents
- Evidence of Coverage English | Español
- Drug List (Formulary) English | Español
- Dental Schedule of Benefits English | Español
- Over-the-Counter (OTC) Catalog English | Español
- Over-the-Counter (OTC) Form English | Español
- Annual Notice of Changes English | Español
- Low Income Subsidy Summary English | Español
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2021 Benefit Year
General Plan Documents
- Evidence of Coverage English | Español
- Drug List (Formulary) English | Español
- Dental Schedule of Benefits English | Español
- Over-the-Counter (OTC) Catalog English | Español
- Over-the-Counter (OTC) Form English | Español
- Annual Notice of Changes English | Español
- Low Income Subsidy Summary English | Español