Medicare document library
We try to minimize paperwork. But sometimes you need a form or other information. And when you need it, you want it to be convenient. We have created a document library to give you easy access to the most requested forms. Select your plan below.
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- Assurance Rx
- Essence/Essence Rx
- Esteem Rx
- Medicare Supplement
- Promise Rx
- Secure Saver MSA
- Spirit/Spirit Rx
- Surety Rx
- Broker
- eNewsCasts
- Ally Rx D-SNP Sales Kit
- Medicare Advantage East Sales Kit
- Medicare Advantage North Sales Kit
- Medicare Advantage South Sales Kit
- Secure Saver MSA Sales Kit
- 2021 Ally Rx DSNP
- 2021 Medicare Advantage HMO POS
- 2021 Secure Saver MSA
- Ascend Rx
- 2020 Medicare Advantage HMO-POS
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2021 Assurance Rx Annual Notice of Changes
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2021 Assurance Rx Evidence of Coverage
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2021 Assurance Rx Evidence of Coverage - Spanish
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2021 Delta Dental Preventive Certificate
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2021 Medicare Advantage Customer Guide - South
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2021 Medicare Advantage HMO Star Rating
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2021 Medicare Advantage HMO-POS Abridged Formulary
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2021 Medicare Advantage HMO-POS Comprehensive Formulary
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2021 Medicare Advantage HMO-POS Drug Prior Authorization List
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2021 Medicare Advantage HMO-POS Enrollment form - South
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2021 Medicare Advantage HMO-POS Pre-enrollment Checklist
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2021 Medicare Advantage HMO-POS Short Enrollment form - South
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2021 Medicare Advantage HMO-POS Summary of Benefits South Assurance Rx/Essence/Essence Rx/Spirit/Spirit Rx
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2021 Medicare Advantage Member Handbook
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2021 Medicare Advantage Pharmacy Directory
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2021 Medicare Advantage Provider Directory - North/South
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2021 Medicare Advantage Provider Directory - North/South - Addendum
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HIPAA Authorization to Use and Disclose Protected Health Information
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Medicare Advantage Automatic Premium Payment Plan
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Member Perks booklet
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Member Prescription Drug Reimbursement Request
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Part D Vaccine Reimbursement Request form
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SilverSneakers Brochure