Medicare document library
Show
- Assurance Rx
- Essence/Essence Rx
- Esteem Rx
- Medicare Supplement
- Promise Rx
- Spirit/Spirit Rx
- Surety Rx
- Broker Tools
- 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
-
2021 Assurance Rx Annual Notice of Changes
A letter sent in September 2020 to inform members about plan changes effective Jan. 1, 2021
-
2021 Assurance Rx Evidence of Coverage
The comprehensive booklet that details the services Assurance Rx HMO-POS plan covers, what the member pays, and plan rules
-
2021 Delta Dental Preventive Certificate
The booklet that explains the preventive dental coverage provided at no charge to the member
-
2021 Medicare Advantage Customer Guide - South
A brochure that explains Medicare Advantage HMO-POS plans, including the costs, benefits and coverage provided beyond Original Medicare
-
2021 Medicare Advantage HMO/D-SNP Star Rating
A sheet that explains the Centers for Medicare and Medicaid Services (CMS) Star Rating achieved by Security Health Plan’s HMO-POS and D-SNP plans
-
2021 Medicare Advantage HMO-POS Abridged Formulary
A list of the most common prescription drugs available to members of a Medicare Advantage HMO-POS plan from Security Health Plan
-
2021 Medicare Advantage HMO-POS Comprehensive Formulary
A comprehensive list of all prescription drugs available to members of a Medicare Advantage HMO-POS plan from Security Health Plan
-
2021 Medicare Advantage HMO-POS Drug Prior Authorization List
A list of prescription drugs available with prior approval to members of a Medicare Advantage HMO-POS plan from Security Health Plan
-
2021 Medicare Advantage HMO-POS Enrollment form - South
Use this form to request enrollment in a Medicare Advantage HMO-POS plan from Security Health Plan
-
2021 Medicare Advantage HMO-POS Pre-enrollment Checklist
Information for potential members to understand the benefits and rules of a Medicare Advantage HMO-POS plan
-
2021 Medicare Advantage HMO-POS Short Enrollment form - South
Use this form to request a plan change from one Security Health Plan Medicare Advantage plan to another
-
2021 Medicare Advantage HMO-POS Summary of Benefits - South
A summary document that details the services a Medicare Advantage HMO-POS plan from Security Health Plan covers and what the member pays
-
2021 Medicare Advantage Member Handbook
“Quick start” guide that explains key benefits and other information to help members use their health plan to the fullest
-
2021 Medicare Advantage Pharmacy Directory
The detailed list of all pharmacies in the network for Security Health Plan’s HMO-POS and D-SNP plans
-
2021 Medicare Advantage Provider Directory - North/South
A list of all health care providers and facilities included in the network for Security Health Plan’s Medicare Advantage north and south regions
-
2021 Medicare Advantage Provider Directory - North/South - Addendum
Monthly updates to the list of health care providers and facilities available in your Medicare Advantage network
-
Appointment of Representation Form
Names a legal representative to receive health information and act on the member’s behalf in regards to a claim, appeal or grievance
-
Assurance Rx Verificación de cobertura de 2021
El folleto completo que detalla lo que cubre el plan Assurance Rx HMO-POS, lo que paga el miembro y las reglas del plan
-
HIPAA Authorization to Use and Disclose Protected Health Information
Use this form to designate individuals you choose to have access to your health information
-
Medicare Advantage Automatic Premium Payment Plan
Use this fillable form to sign up for automatic payment of your Medicare Advantage monthly premium
-
Medicare Advantage Member Prescription Drug Reimbursement Request
Use this form to request reimbursement for prescription drugs you paid for that are covered under your Part D benefits
-
Medicare Advantage Request for Disenrollment
Form used to request disenrollment from a Medicare Advantage plan
-
Medicare Complaint Form
Used to submit a complaint or concern about your Medicare health plan directly to the Centers for Medicare & Medicaid Services
-
Medicare Coverage Inquiry
Form provider uses to request coverage when a member’s treatment or service requires prior authorization by Security Health Plan
-
National Coverage Determination
Periodic updates from the Centers for Medicare & Medicaid Services for new covered services, treatment and procedures
-
Other insurance information
Form to indicate insurance coverage a potential member may have in addition to their Medicare Advantage plan from Security Health Plan
-
Part D Vaccine Reimbursement Request form
Use this form to request reimbursement for vaccines you paid for that are covered under your Part D prescription drug benefits
-
SilverSneakers Brochure
Flyer that describes the SilverSneakers fitness benefits offered free of charge to Security Health Plan’s HMO-POS and D-SNP members