Summary of Benefits
(PDF)
Evidence of Coverage
(PDF)
EOC Appeals & Exceptions
(PDF)
Useful Telephone Numbers
Enrollment Guidelines
Forms
Rights & Responsibilities Upon Disenrollment
(PDF)
Can I Appoint a Representative?
Designate Someone to Speak on My Behalf
HIV Screening Notice
(PDF)
Report Fraud and Abuse
Privacy Notice
(PDF)
Disclaimers
You may qualify for
extra help
with your monthly premium and drug costs.
H4213_Adv 2011 Website Submission CMS Approved 10182010
Web Page Last Updated: 8/30/2011