Member Materials - Medicare Advantage
2017 GENERATIONS MEDICARE ADVANTAGE PLANS, MEMBER MATERIALS, FORMS, RESOURCES & GUIDELINES
Learn more about your 2017 Generations Medicare Advantage Plans 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 Plan Options
Current Drug Formulary
- 2017 Classic Comprehensive Formulary Updated 7/1/2017
- 2017 Select & Premier Comprehensive Formulary Updated 7/1/2017
Summary of Benefits
Benefits at a Glance
Evidence of Coverage (EOC)
- Plan Year 2017 Evidence of Coverage (Generations Value)
- Plan Year 2017 Evidence of Coverage (Generations Classic)
- Plan Year 2017 Evidence of Coverage (Generations Select)
- Plan Year 2017 Evidence of Coverage (Generations Premier)
Annual Notice of Changes (ANOC)
- Annual Notices of Changes for 2017 (Generations Value)
- Annual Notices of Changes for 2017 (Generations Classic)
- Annual Notices of Changes for 2017 (GlobalHealth Medicare Option 1 to Generations Value)
- Annual Notices of Changes for 2017 (GlobalHealth Medicare Option 2 to Generations Select)
- Annual Notices of Changes for 2017 (GlobalHealth Medicare Option 3 to Generations Premier)
- Annual Notices of Changes for 2017 (GlobalHealth Medicare Option 4 to Generations Select)
- Annual Notices of Changes for 2017 (GlobalHealth Medicare Option 5 to Generations Classic)
Enrollment Forms
- 2017 Enrollment Form (All Plan Options - New Members)
- 2017 Short Enrollment Form (All Plan Options – Current Members)
Provider Directory
- Plan Year 2017 Provider Directory (for a current listing, click here.)
Pharmacy Documents, Links and Resources
- Medicare Part D Prescription Claim Form
- Prescription Drug Mail Order Form
- Prescription Drug Transition Policy
- Medicare Therapy Management(MTM) Program Information
- Request for Medicare Prescription Drug Appeal(Redetermination) Form
- Request for Medicare Prescription Drug Coverage Determination Form
- 2017 Step Therapy (Classic)
- 2017 Step Therapy (Select, Premier)
- 2017 Prior Authorization
Additional Documents, Links and Resources
- Plan Year 2017 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
- Preferred Pharmacy Search Tool
- Pharmacy Search Tool
- Formulary Search Tool
- CMS Website's Best Available Evidence (BAE) Page
- Appointment of Representative Form
- Release of Information Form
- Notice of Privacy Practices
Archived Member Materials
2016 Materials for GlobalHealth Medicare (HMO)
- Plan Year 2016 Summary of Benefits (Plan Option 1)
- Plan Year 2016 Summary of Benefits (Plan Options 2, 3, 4, 5)
- Plan Year 2016 Evidence of Coverage (GlobalHealth Medicare Option 1)
- Plan Year 2016 Evidence of Coverage (GlobalHealth Medicare Option 2)
- Plan Year 2016 Evidence of Coverage (GlobalHealth Medicare Option 3)
- Plan Year 2016 Evidence of Coverage (GlobalHealth Medicare Option 4)
- Plan Year 2016 Evidence of Coverage (GlobalHealth Medicare Option 5)