Member Materials - Medicare Advantage
GLOBALHEALTH MEDICARE ADVANTAGE PLANS, MEMBER MATERIALS, FORMS, RESOURCES & GUIDELINES
Learn more about your GlobalHealth Medicare Advantage Plan plan and benefits. Download the latest member materials below. All materials shown are available in printed versions. If you need a printed version, please contact Customer Care and a copy will be mailed to you.
Materials for all 2019 Plan Options
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Summary of Benefits
All in One Guide
Evidence of Coverage (EOC)
- Plan Year 2019 Evidence of Coverage (Generations Value)
- Plan Year 2019 Evidence of Coverage (Generations Classic)
- Plan Year 2019 Evidence of Coverage (Generations Select)
Annual Notice of Changes (ANOC)
- Annual Notice of Changes for 2019 (Generations Value)
- Annual Notice of Changes for 2019 (Generations Classic)
- Annual Notice of Changes for 2019 (Generations Select)
Enrollment Forms (Annual Enrollment Period October 15-December 7)
- 2019 Enrollment Form (All Plan Options - New Members)
- 2019 Short Enrollment Form (All Plan Options – Current Members)
- 2019 Pre-Enrollment Checklist
- 2019 Enrollment Attestation
Provider Directory
- Plan Year 2019 Provider Directory (for a current listing, click here.)
Pharmacy Directory
- Plan Year 2019 Provider Directory (for a current listing, click here.)
Pharmacy Documents, Links and Resources
- Medicare Part D Prescription Claim Form
- Medication Therapy Management (MTM) Program Information
- Over the Counter Benefit
- Prescription Drug Mail Order Form
- Prescription Drug Transition Policy
- Request for Medicare Prescription Drug Coverage Determination Form
- Request for Medicare Prescription Drug Appeal (Redetermination) Form
- Use the above Coverage Determination Form for Exceptions, Prescription Drug Prior Authorization, Quantity Limits, Step Therapy, and Reimbusements.
- Utilization Management Program
Additional Documents, Links and Resources
- Advance Directive Information
- Advance Directive Model Form
- Appointment of Representative Form
- Bank Draft Recurring Payment Authorization Form
- Credit Card Recurring Payment Authorization Form
- CMS Website's Best Available Evidence (BAE) Page
- Dental Benefits
- Disenrollment Rights and Responsibilities
- Fitness Benefits
- This benefit is for Members enrolled in the Generations Select plan.
- Get information about Extra Help to pay your plan premium or prescriptions (LIS)
- Health Information Technology and Price Transparency
- Non-Discrimination Notice
- Notice of Privacy Practices
- Physician Treatment Request Form (Medical Prior Authorization)
- Plan Year 2019 Medicare Star Ratings
- Quality Improvement Program
- Release of Information Form
- Transportation Benefits
- This benefit is for Members with certain chronic conditions.
- Transition of Care Form
- Value-Added Items and Services
- Your Rights and Responsibilities as a Member of a GlobalHealth Medicare Advantage plan
Materials for all 2018 Plan Options
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Summary of Benefits
Benefits Guide
Evidence of Coverage (EOC)
- Plan Year 2018 Evidence of Coverage (Generations Value)
- Plan Year 2018 Evidence of Coverage (Generations Classic)
- Plan Year 2018 Evidence of Coverage (Generations Select)
Annual Notice of Changes (ANOC)
- Annual Notice of Changes for 2018 (Generations Value)
- Annual Notice of Changes for 2018 (Generations Classic)
- Annual Notice of Changes for 2018 (Generations Select)
- Annual Notice of Changes for 2018 (Generations Premier)
Enrollment Forms
- 2018 Enrollment Form (All Plan Options - New Members)
- 2018 Short Enrollment Form (All Plan Options – Current Members)
Provider Directory
- Plan Year 2018 Provider Directory (for a current listing, click here.)
Pharmacy Documents, Links and Resources
- 2018 Pharmacy Search Tool
- Over the Counter Benefit (Generations Value & Generations Classic plans only)
- Medicare Part D Prescription Claim Form
- Prescription Drug Mail Order Form
- Prescription Drug Transition Policy
- Medication Therapy Management (MTM) Program Information
- Utilization Management Program
- Request for Medicare Prescription Drug Appeal (Redetermination) Form
- Request for Medicare Prescription Drug Coverage Determination Form
Additional Documents, Links and Resources
- Plan Year 2018 Medicare Star Ratings
- Non-Discrimination Notice
- Get information about Extra Help to pay your plan premium or prescriptions (LIS)
- Credit Card Recurring Payment Authorization Form
- Bank Draft Recurring Payment Authorization Form
- Your Rights and Responsibilities as a Member of Generations Medicare Advantage plan, offered by GlobalHealth
- Advance Directive Information
- Advance Directive Model Form
- CMS Website's Best Available Evidence (BAE) Page
- Appointment of Representative Form
- Release of Information Form
- Notice of Privacy Practices
- Transition of Care Form