2017 Benefits & Resources

2018 Benefits & Resources

Documents

Summary of Benefits
Annual Notice of Change
Evidence of Coverage
Formulary
Formulary Changes
Provider Directory: New York Queens Richmond Suffolk Kings Nassau Bronx
Provider Directory Addendum
Over-the-Counter Benefit

Multi-language Interpreter Services
Medicare Star Ratings
Medicaid Member Handbook
Privacy Notice
Low Income Subsidy (LIS) Premium Summary Chart
Medicare Part D Transition Policy
Part D Prior Authorization Criteria
Part D Step Therapy Criteria

Pharmacy Quality Assurance
Medication Therapy Management Program
Medication Safety
Personal Medication List
Passport to Good Health Rewards Program
National Coverage Determinations (NCD)
Grievances, Appeals, Organization and Coverage Determinations   
Pharmacy Directory
Locate a Dental Provider
Locate a Provider
Locate a Pharmacy
Request Provider/Pharmacy Directory or List of Covered Drugs (Formulary) by Mail
Part D Authorization Portal
Non-Discrimination Notice

Enrollment Forms
Medicare Advantage Enrollment
Medicaid Advantage Plus Enrollment Form

Medicare Advantage Prescription Drug Request
Request for Medicare Prescription Drug Coverage Determination
Request for Redetermination of Medicare Prescription Drug Denial
Prescription Drug Claim Form
Prescription Drug Mail Order Form

How to appoint a representative
New York State Health Care Proxy
Appointment of Representative Form – CMS 1696

Provider Materials
Fraud, Waste and Abuse Training for Providers
GuildNet Gold Model of Care
Emblem Provider Manual
GuildNet Provider Manual
Provider Portal Instructions

H6864_GN517_2017Website_Approved
Last Updated: 11/2/17