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.
Member Newsletters
Materials for all 2021 Plan Options
Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information
Summary of Benefits
All in One Guide
- Plan Year 2021 All in One Guide (Updated 10/19/2020)
- 2021 Pre-Enrollment Checklist
- 2021 Star Ratings (English) (Spanish)
Evidence of Coverage (EOC)
- Plan Year 2021 Evidence of Coverage (Generations Value)
- Plan Year 2021 Evidence of Coverage (Generations Classic)
- Plan Year 2021 Evidence of Coverage (Generations Select)
- Plan Year 2021 Evidence of Coverage (Generations Classic Choice)
Member Letter - Important information regarding behavioral health telehealth visits
Annual Notice of Changes (ANOC)
- Annual Notice of Changes for 2021 (Generations Value)
- Annual Notice of Changes for 2021 (Generations Classic)
- Annual Notice of Changes for 2021 (Generations Select)
Enrollment Forms (Annual Enrollment Period October 15-December 7)
- 2021 Enrollment Form (All Plan Options - New Members)
- 2021 Pre-Enrollment Checklist
- 2021 Enrollment Attestation
Provider Directory
- Plan Year 2021 Provider Directory (for a current listing, click here.)
Pharmacy Directory
- Plan Year 2021 Pharmacy Directory (for a current listing, click here.)
Pharmacy Documents, Links and Resources
- Medicare Part D Prescription Claim Form
- 2021 Pharmacy Search Tool
- Prescription Drug Mail Order Form
- For more information, please visit https://www.caremark.com/manage-prescriptions/rx-delivery-by-mail.html.
- Prescription Drug Transition Policy
- Medication Therapy Management (MTM) Program Information
- Utilization Management Program
- 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.
- Over the Counter Benefit
Please note when ordering OTC items online, you should not enter the “01” located at the end of your GlobalHealth member ID number. If the “01” is entered, the member ID number will not be recognized.
Additional Documents, Links and Resources
- Advance Directive Information
- Appointment of Representative Form
- Assistance During a Disaster
- 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
- Healthy Living Tips
- National Coverage Determinations (NCD) and Local Coverage Determinations (LCD)
- Non-Discrimination Notice
- Physician Treatment Request Form (Medical Prior Authorization)
- Plan Year 2021 Medicare Star Ratings (English) (Spanish)
- Privacy Notice
- 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
Click here for member materials prior to 2021.