Generations Medicare Advantage Archives
Generations Medicare Advantage Archives
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
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.
- 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
- Healthy Living Tips
- 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
- 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
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, click here.
Pharmacy Directory
- Plan Year 2019 Pharmacy Directory, 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 was for Members who were enrolled in the Generations Select plan in 2019.
- 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 was 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