MEMBER INFORMATION

Please click on the links below for more information on each topic:

• General Information and Forms
  • Extra Help (Low Income Subsidy) / Best Available Evidence
  • How to Appoint a Representative
  • Member Rights & Responsibilities
  • Notice of Nondiscrimination
  • Language Availability
  • Vitality Service Area
• Member Documents for 2019
  • Summary of Benefits
  • Drug Formulary (List of Covered Drugs)
  • Provider and Pharmacy Directory
  • Enrollment Form
  • Low Income Subsidy (LIS) Premium Summary Chart
  • Dental Benefit Book
  • Over-The-Counter Catalog
  • Evidence of Coverage (EOC)
• Prior Authorization (Organization and Coverage Determinations) Exceptions
  • For Medical Care
  • For Drugs
• How to File an Appeal
  • For Medical Care
  • For Drugs
• How to File a Grievance/Complaint
• Prescription Drug/ Medication Information
  • Medication Transition Process
  • Drug Utilization Management
  • Drug Quality Assurance Policy
  • Medication Therapy Management Program
• Fraud, Waste, and Abuse
• Medicare Star Rating