1. To find documents related to your coverage, start by selecting
your state and your Medicare plan.
2. Select the state you reside in.
4. Download Plan Documents
General Documents
- CSNP Enrollment Form
- CSNP Enrollment Application
- MAPD Attestation & Enrollment Form
- MAPD Enrollment Application
- MAPD Scope of Appointment
- MAPD Enrollment Form
- Over-the-Counter (OTC) Product Catalog
- List of Covered Dental Procedures
- Admissions Form
- Appeal Form
- Appointment of Representative Form
- Coverage Determination Request Form
- Disenrollment Form
- Grievance Form
- Mail Order Drug Form
- Medical Reimbursement Claim Form
- Medication Therapy Management (MTM) Overview
- Medication Therapy Management (MTM) - Personal Rx List
- Prescription Drug Claim Form
- Privacy (HIPAA) Authorization Form
- Prior Authorization - Medical Services List
- Prior Authorization - Medical Services Form
- Prior Authorization - Rx Criteria
- Pre-Enrollment Checklist