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 2020 Plan Options
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Summary of Benefits
All in One Guide
- Plan Year 2020 All in One Guide (Updated 10/16/2019)
Evidence of Coverage (EOC)
- Plan Year 2020 Evidence of Coverage (Generations Value)
- Plan Year 2020 Evidence of Coverage (Generations Classic)
- Plan Year 2020 Evidence of Coverage (Generations Select)
Annual Notice of Changes (ANOC)
- Annual Notice of Changes for 2020 (Generations Value)
- Annual Notice of Changes for 2020 (Generations Classic)
- Annual Notice of Changes for 2020 (Generations Select)
Enrollment Forms (Annual Enrollment Period October 15-December 7)
- 2020 Enrollment Form (All Plan Options - New Members)
- 2020 Short Enrollment Form (All Plan Options – Current Members)
- 2020 Pre-Enrollment Checklist
- 2020 Enrollment Attestation
Provider Directory
- Plan Year 2020 Provider Directory (for a current listing, click here.)
Pharmacy Directory
- Plan Year 2020 Pharmacy 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 Reimbursements.
- Utilization Management Program
Additional Documents, Links and Resources
- Advance Directive Information
- Appointment of Representative Form
- Assistance During a Disaster
- 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
- 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 2020 Medicare Star Ratings (Updated 10/15/19)
- Quality Improvement Program
- Release of Information Form
- Tobacco Cessation
- 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 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 Pharmacy 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 Reimbursements.
- 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