Plan Documents

Your plan includes important documents that explain your benefits, costs and coverage. To protect your personal information, some of these documents are only available when you sign in to My Account. This includes your Evidence of Coverage (EOC), Summary of Benefits (SB), Annual Notice of Change (ANOC) when available, and Explanation of Benefits (EOBs).

Please note: Benefits, coverage and availability vary by plan. Sign in to My Account to access your group-specific plan documents that contain the complete details about your coverage.

Provider Network

Medical Provider Directory

English | Spanish

Dental Directory (if included in your plan)

English | Spanish

Vision Directory (if included in your plan)

English | Spanish

Hearing Directory (if included in your plan)

English | Spanish

Plan Forms

Health Benefits Claims Form

Dental Claim Form (if included in your plan)

Designation of Personal Representative Form

MCG Clinical Guidelines

Appointment of Representative Form

Prescription Drug Documents (if included in your plan)

Prescription Drug Coverage Determination Form

English | Spanish

Prescription Drug Coverage Redetermination Form

English Spanish

Prescription Drug Coverage Reconsideration Form

English | Spanish

Prescription Drug Coverage Mail Order Form

English | Spanish

Search your plan-specific Prescription Drug Documents including your formulary and any applicable drug riders.

Additional Resources

Caregiver Resources

Medicare and You Handbook

Provider Network

Care Management

Medicare Star Ratings

2026 Plan Rating

English | Spanish

Please note: Benefits, coverage and availability vary by plan. Sign in to My Account to access your group-specific plan documents that contain the complete details about your coverage.

Provider Network

Medical Provider Directory

English | Spanish

Dental Directory (if included in your plan)

English | Spanish

Vision Directory (if included in your plan)

English | Spanish

Hearing Directory (if included in your plan)

English | Spanish

Plan Forms

Health Benefits Claims Form

Dental Claim Form (if included in your plan)

Designation of Personal Representative Form

MCG Clinical Guidelines

Appointment of Representative Form

Prescription Drug Documents (if included in your plan)

Prescription Drug Coverage Determination Form

English | Spanish

Prescription Drug Coverage Redetermination Form

English Spanish

Prescription Drug Coverage Reconsideration Form

English | Spanish

Prescription Drug Coverage Mail Order Form

English | Spanish

Search your plan-specific Prescription Drug Documents including your formulary and any applicable drug riders.

Additional Resources

Caregiver Resources

Medicare and You Handbook

Provider Network

Care Management

Medicare Star Ratings

2027 Plan Rating

English | Spanish