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

January 2020 Issue

Materials for all 2020 Plan Options

Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information

• Click here for current 2020 versions

Summary of Benefits

• Plan Year 2020 Summary of Benefits (All Plan Options)

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 
  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.
  
  • Over the Counter Benefit – Place Order
  • Over the Counter Benefit FAQs
  • Over the Counter Benefit Catalog (Updated 4/15/2020)
• 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
• National Coverage Determinations (NCD) and Local Coverage Determinations (LCD)
• Non-Discrimination Notice
• Physician Treatment Request Form (Medical Prior Authorization)
• Plan Year 2020 Medicare Star Ratings (Updated 10/15/19)
• 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 2020.