2024 Plan Information

The information provided here is intended to be a summary of our plan, effective January 1, 2024.

Member Handbook - Evidence of Coverage (EOC)

  • Member Handbook - Evidence of Coverage (EOC) (English)
  • Member Handbook - Evidence of Coverage (EOC) (Spanish)
  • Member Handbook - Evidence of Coverage (EOC) (Arabic)
  • Member Handbook - Evidence of Coverage (EOC) (Vietnamese)
  • Member Handbook - Evidence of Coverage (EOC) (Tagalog)
  • Member Handbook - Evidence of Coverage (EOC) (Chinese)
  • Member Handbook - Evidence of Coverage (EOC) (Farsi)

Combined Pharmacy/Provider Directory 

  • Combined Pharmacy/Provider Directory (English)
  • Combined Pharmacy/Provider Directory (Spanish)
  • Combined Pharmacy/Provider Directory (Arabic)
  • Combined Pharmacy/Provider Directory (Vietnamese)
  • Combined Pharmacy/Provider Directory (Tagalog)
  • Combined Pharmacy/Provider Directory (Chinese)
  • Combined Pharmacy/Provider Directory (Farsi)

List of Covered Drugs (Formulary) 

  • List of Covered Drugs (Formulary) (English)
  • List of Covered Drugs (Formulary) (Spanish)
  • List of Covered Drugs (Formulary) (Arabic)
  • List of Covered Drugs (Formulary) (Vietnamese)
  • List of Covered Drugs (Formulary) (Tagalog)
  • List of Covered Drugs (Formulary) (Chinese)
  • List of Covered Drugs (Formulary) (Farsi)
  • Pharmacy Prior Authorization Criteria
  • Pharmacy Step Therapy Criteria (English)

Summary of Benefits 

  • Summary of Benefits (English)
  • Summary of Benefits (Spanish)
  • Summary of Benefits (Arabic)
  • Summary of Benefits (Vietnamese)
  • Summary of Benefits (Tagalog)
  • Summary of Benefits (Chinese)
  • Summary of Benefits (Farsi)  
  • Drug Transition Policy 2023

Over-the Counter (OTC) Benefit

  • Over-the-Counter Benefit Catalog 
  • Over-The-Counter Benefits Catalog - Spanish
  • Over-The-Counter Benefits Catalog - Vietnamese

Forms

Additional Member Resources

Please click on the following link to access Centers for Medicare & Medicaid Services website:

www.cms.gov

Please click on the following link to access the Medicare and You Handbook:

Medicare and You Handbook

Please click on the following link to obtain information on help with prescription drug costs:

https://www.ssa.gov/benefits/medicare/prescriptionhelp/

Disclaimers

Community y Más (HMO C-SNP) is an HMO C-SNP health plan with a Medicare contract. Enrollment in this plan depends on contract renewal.

 

ATTENTION: If you speak another language, language assistance services, free of charge, are available to you. Call 1-800-232-3133, TTY users should call 1-855-266-4584, 24 hours a day, 7 days a week. The call is free.

 

ATENCIÓN: Si habla español, hay servicios de asistencia de idiomas disponibles sin cargo. Llame al 1-800-232-3133 (TTY: 1-855-266-4584). Las llamadas a estos números son gratuitas.

 

请注意：如果您说简体中文，可免费获得语言援助服务。请致电 1-800-232-3133（听障专线：1-855-266-4584）。通话免费。

 

PANSININ: Kung nagsasalita kayo ng ibang wika, may mga paglingkod na pagtulong sa wika na maabot ninyo, na libre. Tawagan ang 1-800-232-3133 (TTY: 1-855-266-4584). Liber ang tawag na ito.

 

請注意：如果您說繁體中文，可免費獲得語言援助服務。請致電 1-800-232-3133（聽障專線：1-855-266-4584）。通話免費。

 

CHÚ Ý: Nếu bạn nói tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ, miễn phí, sẽ có sẵn cho bạn. Gọi số 1-800-232-3133 (TTY: 1-855-266-4584). Cuộc gọi được miễn phí.

 

1-888-244-4430 تنبيه: إذا كنت تتحدث اللغة العربية ، فأن خدمات المساعدة اللغوية متاحة لك بدون اي مقابل. إتصل بالرقم :

1-855-266-4584او الهاتف النصي :

كلا الرقمين متوفرين ٢٤ ساعة باليوم ٧ أيام بالاسبوع.

 

توجه: اگر به زبان فارسی صحبت می‌کنید، خدمات کمک زبانی، به صورت رایگان، در اختیار شماست. با 4430-244-888-1 (پیام‌نگار: 1-855-266-4584) تماس بگیرید. تماس با این شماره‌ها رایگان است.

 

 

Last Website Update 12/01/2023
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