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 Plan Options
| Document Name | Language | Action |
|---|---|---|
| Drug Formulary, Pharmacy Prior Authorization and Step Therapy Information | ||
| Current 2022 Versions | English | View |
| Current 2021 Versions | English | View |
| Summary Of Benefits | ||
| Generations Classic (HMO), Generations Value (HMO), Generations Select (HMO) and Generations Classic Choice (HMO-POS) Plan Year 2022 |
English | View |
| Generations Classic Plus (HMO), Generations Special Care (HMO C-SNP) and Generations Special Care Savings (HMO C-SNP) Plan Year 2022 |
English | View |
| All Plan Options Plan Year 2021 |
English | View |
| Benefit Overview | ||
| Plan Year 2022 (Updated 10/01/2021) | English | View |
| Plan Year 2022 (Updated 10/01/2021) | Espanol | View |
| 2022 Star Ratings | English | View |
| 2022 Star Ratings | Espanol | View |
| Plan Year 2021 All in One Guide(Updated 10/19/2020) | English | View |
| 2021 Star Ratings | English | View |
| 2021 Star Ratings | Espanol | View |
| Evidence Of Coverage (EOC) | ||
| Generations Value (HMO) - H3706-009 - Plan Year 2022 | English | View |
| Generations Value (HMO) - H3706-009 - Plan Year 2022 | Espanol | View |
| Generations Value (HMO) - H3706-009 - Plan Year 2021 | English | View |
| Generations Classic (HMO) - H3706-001 - Plan Year 2022 | English | View |
| Generations Classic (HMO) - H3706-001 - Plan Year 2022 | Espanol | View |
| Generations Classic (HMO) - H3706-001 - Plan Year 2021 | English | View |
| Generations Classic Choice (HMO-POS) - H3706-021- Plan Year 2022 | English | View |
| Generations Classic Choice (HMO-POS) - H3706-021 - Plan Year 2022 | Espanol | View |
| Generations Classic Choice (HMO-POS) - H3706-021 - Plan Year 2021 | English | View |
| Generations Classic Plus (HMO) - H3706-022 - Plan Year 2022 | English | View |
| Generations Classic Plus (HMO) - H3706-022 - Plan Year 2022 | Espanol | View |
| Generations Classic Plus (HMO) - H3706-023 - Plan Year 2022 | English | View |
| Generations Classic Plus (HMO) - H3706-023 - Plan Year 2022 | Espanol | View |
| Generations Select (HMO) - H3706-018 - Plan Year 2022 | English | View |
| Generations Select (HMO) - H3706-018 - Plan Year 2022 | Espanol | View |
| Generations Select (HMO) - H3706-018 - Plan Year 2021 | English | View |
| Generations Special Care (HMO C-SNP) - H3706-024 - Plan Year 2022 (updated 11/15/2021) | English | View |
| Generations Special Care (HMO C-SNP) – H3706-024 – Plan Year 2022 erratum | English | View |
| Generations Special Care (HMO C-SNP) - H3706-024 - Plan Year 2022 (updated 11/15/2021) | Espanol | View |
| Generations Special Care (HMO C-SNP) - H3706-024 - Plan Year 2022 erratum | Espanol | View |
| Generations Special Care Savings (HMO C-SNP) - H3706-025 - Plan Year 2022 (updated 11/15/2021) | English | View |
| Generations Special Care Savings (HMO C-SNP) – H3706-025 – Plan Year 2022 erratum | English | View |
| Generations Special Care Savings (HMO C-SNP) - H3706-025 - Plan Year 2022 (updated 11/15/2021) | Espanol | View |
| Generations Special Care Savings (HMO C-SNP) - H3706-025 - Plan Year 2022 erratum | Espanol | View |
| 2021 Member Letter | English | View |
| Annual Notice of Changes (ANOC) | ||
| Generations Value (HMO) - 2022 | English | View |
| Generations Value (HMO) - 2022 | Espanol | View |
| Generations Value (HMO) - 2021 | English | View |
| Generations Classic (HMO) - 2022 | English | View |
| Generations Classic (HMO) - 2022 | Espanol | View |
| Generations Classic (HMO) - 2021 | English | View |
| Generations Classic Choice (HMO-POS) - 2022 | English | View |
| Generations Classic Choice (HMO-POS) - 2022 | Espanol | View |
| Generations Classic Choice (HMO-POS) - 2021 | English | View |
| Generations Select (HMO) - 2022 | English | View |
| Generations Select (HMO) - 2022 | Espanol | View |
| Generations Select (HMO) - 2021 | English | View |
| Enrollment Forms (Annual Enrollment Period October 15- December 7) | ||
| 2022 Enrollment Form (All Plan Options - New Members) | English | View |
| 2022 Enrollment Attestation | English | View |
| 2022 Pre-Enrollment Checklist | English | View |
| 2021 Enrollment Form (All Plan Options - New Members) | English | View |
| 2021 Enrollment Attestation | English | View |
| 2021 Pre-Enrollment Checklist | English | View |
| Provider Directory | ||
| Plan Year 2021 and 2022 | English | View |
| Plan Year 2022 [PDF] | English | View |
| Plan Year 2022 [PDF] | Espanol | View |
| Pharmacy Directory | ||
| Plan Year 2021 and 2022 | English | View |
| Important Links | Language | Action |
|---|---|---|
| Pharmacy | ||
| Medicare Part D Prescription Claim Form | English | View |
| 2022 Pharmacy Search Tool | English | View |
| 2021 Pharmacy Search Tool | English | View |
| Prescription Drug Mail Order Form | English | View |
| Prescription Drug Mail Order Form | Espanol | View |
| Prescription Drug Transition Policy | English | View |
| Medication Therapy Management (MTM) Program Information | English | View |
| Utilization Management Program | English | View |
| Request for Medicare Prescription Drug Coverage Determination Form | English | View |
| Request for Medicare Prescription Drug Appeal (Redetermination) Form | English | View |
| Request for Prescription Drug Prior Authorization Exception | English | View |
| Request for Prescription Drug Quantity Limits | English | View |
| Request for Prescription Drug Step Therapy Exception | English | View |
| Request for Prescription Drug Reimbursements | English | View |
| Over the Counter Benefit – Place Order | English | View |
| 2021 Over the Counter Benefit FAQs | English | View |
| 2022 Over the Counter Benefit Catalog (Updated 10/01/2021) | English | View |
| 2021 Over the Counter Benefit Catalog (Updated 10/01/2020) | English | View |
| Additional Documents | Language | Action |
|---|---|---|
| Advance Directive Information | English | View |
| Appointment of Representative Form | English | View |
| Assistance During a Disaster | English | View |
| CMS Website's Best Available Evidence (BAE) Page | English | View |
| Dental Benefits | English | View |
| Direct Member Reimbursement Form | English | View |
| Disenrollment Rights and Responsibilities | English | View |
| Fitness Benefits | English | View |
| Get information about Extra Help to pay your plan premium or prescriptions (LIS) | English | View |
| National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) | English | View |
| Non-Discrimination Notice | English | View |
| Physician Treatment Request Form (Medical Prior Authorization) | English | View |
| Plan Year 2022 Medicare Star Ratings | English | View |
| Plan Year 2022 Medicare Star Ratings | Espanol | View |
| Plan Year 2021 Medicare Star Ratings | English | View |
| Plan Year 2021 Medicare Star Ratings | Espanol | View |
| Privacy Notice | English | View |
| Quality Improvement Program | English | View |
| Release of Information Form | English | View |
| Transportation Benefits | English | View |
| Transition of Care Form | English | View |
| Value-Added Items and Services | English | View |
| Your Rights and Responsibilities as a Member of a GlobalHealth Medicare Advantage plan | English | View |
Click here for member materials prior to 2021.