Plan Materials
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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
eSign Online Forms
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
