Plan Materials
2025 Annual Notice of Changes (ANOC)
2025 Summary of Benefits
2025 Evidence of Coverage
2025 Formulary
2025 Extra Help Premium Summary Table
Multi-Language Insert
Language Assistance and Notice of Non-Discrimination (LANN)
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
2025 Medicare Star Ratings
MedImpact Forms
MedImpact Direct Referral Form
MID Mail Order Form English (updated 1/2025)
MID Mail Order Form Spanish (updated 1/2025)
MID Mail Order Form Chinese (updated 1/2025)
Plan Resources
Member Resources
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New York Medicaid Choice – Enrollment Broker
CMS Best Available Evidence Policy
Submit a complaint to Medicare
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