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Evidence of Coverage 2017

Click on a link below to download a printable PDF.


Eligibility Requirements

To enroll in our plans you must meet the following requirements:

  1. You must be entitled to Medicare Part A and D and enrolled in Part B provided that you will be entitled to receive services under Medicare Part A and Part B as of the effective date of coverage under the plan
  2. You must permanently reside in the service area of the plan.
  3. You must not have ESRD prior to completing the enrollment request.
  4. You must make a valid enrollment request that is received by the plan during an election period.
  5. For those enrolling in a Special Needs Plan (SNP) you must meet the eligibility requirements for the specific SNP.

Rights and Responsibilities

If you choose to leave our plan you have the following rights and responsibilities:

  1. You may end your membership in our plan only during certain times of the year, known as enrollment periods.
  2. You should continue to use our network providers and pharmacies to get your medical services and prescriptions filled until your membership in our plan ends.
  3. You have the right to obtain a disenrollment notice within 10 calendar days.
  4. You have the right to file a grievance with our plan.

For detailed information please refer to each plan's Evidence of Coverage document.