Evidence of Coverage 2022
Click here for 2023 Evidence
Click on the link with the name of your plan to review it or
download it in a printable PDF format.
To enroll in our plans you must meet the following
- 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
- You must permanently reside in the service area of the
- You must not have ESRD prior to completing the enrollment
- You must make a valid enrollment request that is received by
the plan during an election period.
- For those enrolling in a Special Needs Plan (SNP) you must meet
the eligibility requirements for the specific SNP.
If you choose to leave our plan you have the following rights
- You may end your membership in our plan only during certain
times of the year, known as enrollment periods.
- 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.
- You have the right to obtain a disenrollment notice within 10
- You have the right to file a grievance with our plan.
For detailed information please refer to each plan's Evidence of