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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. You may also request a copy to be mailed to you by logging into your Member Portal .

Materials for all Plan Options

Unless otherwise stated, all plans are HMO and require referrals from your Primary Care Physician.

2026
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2026
Plan Year Documents
English Spanish

Please select a plan from the dropdowns to view documents.

No plans are available for the year 2024.

Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 02/23/2026) Evidencia De Cobertura (Updated 01/01/2026)
Annual Notice Of Changes Aviso Anual De Cambios
2026 Comprehensive Formulary (Updated on 05/21/2026)  2026 Comprehensive Formulary (Updated on 05/21/2026)
2026 Formulary Changes  
2026 Step Therapy Criteria (Updated on 05/21/2026)  
2026 Prior Authorization Criteria (Updated on 05/21/2026)  
2026 Part B Prior Authorization Criteria (Updated on 03/17/2026)  
2026 Medicare Part B Step Therapy List (Updated on 01/01/2026)  
2026 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 06/01/2026) GlobalHealth Pharmacy Directory (Updated 06/01/2026)
Most Current List of participating Pharmacies
C-SNP Plans - Pre-Enrollment Qualification Assessment Tool C-SNP Plans - Pre-Enrollment Qualification Assessment Tool
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 02/23/2026) Evidencia De Cobertura (Updated 01/01/2026)
Annual Notice Of Changes Aviso Anual De Cambios 
Annual Notice Of Changes - Errata
2026 Comprehensive Formulary (Updated on 05/21/2026)  2026 Comprehensive Formulary (Updated on 05/21/2026)
2026 Formulary Changes  
2026 Step Therapy Criteria (Updated on 05/21/2026)  
2026 Prior Authorization Criteria (Updated on 05/21/2026)  
2026 Part B Prior Authorization Criteria (Updated on 03/17/2026)  
2026 Medicare Part B Step Therapy List (Updated on 01/01/2026)  
2026 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 06/01/2026) GlobalHealth Pharmacy Directory (Updated 06/01/2026)
Most Current List of participating Pharmacies
C-SNP Plans - Pre-Enrollment Qualification Assessment Tool C-SNP Plans - Pre-Enrollment Qualification Assessment Tool
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 01/01/2026) Evidencia De Cobertura (Updated 01/01/2026)
Annual Notice Of Changes Aviso Anual De Cambios
2026 Comprehensive Formulary (Updated on 05/21/2026)  2026 Comprehensive Formulary (Updated on 05/21/2026)
2026 Formulary Changes  
2026 Step Therapy Criteria (Updated on 05/21/2026)  
2026 Prior Authorization Criteria (Updated on 05/21/2026)  
2026 Part B Prior Authorization Criteria (Updated on 03/17/2026)  
2026 Medicare Part B Step Therapy List (Updated on 01/01/2026)  
2026 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 06/01/2026) GlobalHealth Pharmacy Directory (Updated 06/01/2026)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 01/01/2026) Evidencia De Cobertura (Updated 01/01/2026)
Annual Notice Of Changes Aviso Anual De Cambios
2026 Comprehensive Formulary (Updated on 05/21/2026)  2026 Comprehensive Formulary (Updated on 05/21/2026)
2026 Formulary Changes  
2026 Step Therapy Criteria (Updated on 05/21/2026)  
2026 Prior Authorization Criteria (Updated on 05/21/2026)  
2026 Part B Prior Authorization Criteria (Updated on 03/17/2026)  
2026 Medicare Part B Step Therapy List (Updated on 01/01/2026)  
2026 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 06/01/2026) GlobalHealth Pharmacy Directory (Updated 06/01/2026)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 01/01/2026) Evidencia De Cobertura (Updated 01/01/2026)
Annual Notice Of Changes Aviso Anual De Cambios
2026 Comprehensive Formulary (Updated on 05/21/2026) 2026 Comprehensive Formulary (Updated on 05/21/2026)
2026 Formulary Changes  
2026 Step Therapy Criteria (Updated on 05/21/2026)  
2026 Prior Authorization Criteria (Updated on 05/21/2026)  
2026 Part B Prior Authorization Criteria (Updated on 03/17/2026)  
2026 Medicare Part B Step Therapy List (Updated on 01/01/2026)  
2026 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 06/01/2026) GlobalHealth Pharmacy Directory (Updated 06/01/2026)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 01/01/2026) Evidencia De Cobertura (Updated 01/01/2026)
Annual Notice Of Changes Aviso Anual De Cambios
2026 Comprehensive Formulary (Updated on 05/21/2026) 2026 Comprehensive Formulary (Updated on 05/21/2026)
2026 Formulary Changes  
2026 Step Therapy Criteria (Updated on 05/21/2026)  
2026 Prior Authorization Criteria (Updated on 05/21/2026)  
2026 Part B Prior Authorization Criteria (Updated on 03/17/2026)  
2026 Medicare Part B Step Therapy List (Updated on 01/01/2026)  
2026 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 06/01/2026) GlobalHealth Pharmacy Directory (Updated 06/01/2026)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 01/01/2026) Evidencia De Cobertura (Updated 01/01/2026)
Annual Notice Of Changes Aviso Anual De Cambios
2026 Comprehensive Formulary (Updated on 05/21/2026) 2026 Comprehensive Formulary (Updated on 05/21/2026)
2026 Formulary Changes  
2026 Step Therapy Criteria (Updated on 05/21/2026)  
2026 Prior Authorization Criteria (Updated on 05/21/2026)  
2026 Part B Prior Authorization Criteria (Updated on 03/17/2026)  
2026 Medicare Part B Step Therapy List (Updated on 01/01/2026)  
2026 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 06/01/2026) GlobalHealth Pharmacy Directory (Updated 06/01/2026)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage Evidencia De Cobertura
Annual Notice Of Changes Aviso Anual De Cambios
All Plans - 2026 Enrollment Request Form All Plans - 2026 Enrollment Request Form
For OMES EGID enrollment forms, please contact the employer group  
Benefit Overview Plan Year 2026 Benefit Overview Plan Year 2026
Star Ratings - 2026 Star Ratings - 2026
Notice of availability Notice of availability

 

All Plans - Additional Documents
Provider Directory
English Spanish
Provider Directory - Updated 05/07/2026 Directorio de Proveedores - actualizado 05/07/2026
Provider Addenda January 2026 - Updated 01/03/2026 Directorio de Proveedores enero 2026- actualizado 01/03/2026
Provider Addenda February 2026 - Updated 02/03/2026 Directorio de Proveedores febrero 2026 - actualizado 02/03/2026
Provider Addenda March 2026 - Updated 03/03/2026 Directorio de Proveedores marzo 2026 - actualizado 03/03/2026
Pharmacy
English Spanish
Medicare Part D Prescription Claim Form Medicare Part D Prescription Claim Form
Prescription Drug Mail Order Form Prescription Drug Mail Order Form
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 Coverage Determination Form
Request for Medicare Prescription Drug Appeal (Redetermination) Form Request for Medicare Prescription Drug Appeal (Redetermination) Form
Request for Prescription Drug Prior Authorization Exception Request for Prescription Drug Prior Authorization Exception
Request for Prescription Drug Quantity Limits Request for Prescription Drug Quantity Limits
Request for Prescription Drug Step Therapy Exception Request for Prescription Drug Step Therapy Exception
Request for Prescription Drug Reimbursements Request for Prescription Drug Reimbursements
Over the Counter Benefit – Place Order  
Extra Help to pay your plan premium or prescriptions (LIS)  
Pharmacy FAQ
English Spanish
What is a Formulary  
What is a Late Penalty for Part D  
Legal Documents
Member Reimbursement
English Spanish
Direct Member Reimbursement Form - Online Form - Routine Vision Exam/Eyewear  
Direct Member Reimbursement Form - Mail In Form - Routine Vision Exam/Eyewear  
Direct Member Reimbursement Form - Other Medical Services Direct Member Reimbursement Form - Other Medical Services
Extra Documents
English Spanish
Best Available Evidence (BAE) - from CMS  
Quality Improvement Program  
Remember to Take Your Medication  
2026 Health Risk Assessment (HRA) 2026 Health Risk Assessment (HRA)
Smart Wallet Approved Items  
Member Incentive Program  
Member Health Tools
English Spanish
Blood pressure log  
Member Newsletters
English Spanish
February 2026 Issue  
May 2026 Issue