Plan Materials & Forms

Summary of Benefits English Español
Participant Handbook English Español
Over-the-Counter Benefit English Español

Pharmacy

List of Covered Drugs (Formulary) English Español
Formulary Changes
Medicare Part D Transition Policy
Part D Quality Assurance Policy
Medication Therapy Managment Program
Part D Prior Authorization Criteria
Part D Step Therapy Criteria
Can you ask for an exception to cover your drug?
Personal Medication List

Forms

Part D Coverage Determination Form
Part D Reconsideration Form

Prescription Claim Reimbrusement Form

Prescription Drug Mail Order Form
New York State Health Care Proxy Form English Español
Appointment of Representative Form

GuildNet Gold Plus FIDA Provider and Pharmacy Directory

Provider & Pharmacy Directory:
New York: English Español Queens: English Español Richmond: English Español Kings: English Español Bronx: English Español
Request Provider, Pharmacy Directory or List of Covered Drugs (Formulary) by Mail
Provider Directory Addendum

Important Links and Resources

Medicare Star Ratings English Español
Your Rights and Responsibilities upon Disenrollment
Grievances Exceptions Coverage Determinations & Appeals
Independent Consumer Advocacy Network
Medicare Complaint Form
NY Medicaid Choice
Passport to Good Health Rewards Program

FIDA Participant Advisory Committee (PAC) Meetings

GuildNet invites GuildNet Gold Plus FIDA Plan participants to participate in Participant Advisory Committee (PAC) / Town Hall / Feedback sessions, which meet quarterly.  GuildNet ensures that GuildNet Gold Plus FIDA participants have access to the FIDA PAC/Town Hall/Feedback Sessions, either in-person or remotely. GuildNet assists Participants with transportation, reasonable accommodations to meet Participants’ needs, translation services and other support to help attend the in-person meetings and light refreshments are provided. In addition, the meetings may be telephonic and at least one call focuses on family caregivers, in addition to participants. Summaries of the FIDA PAC Town Hall/Feedback sessions are available on the GuildNet website. Participants are invited to identify problems and concerns at these meetings/calls and provide positive feedback. GuildNet staff provide updates and Frequently Asked Questions (FAQs), as well as other vital information to participants.

FIDA participants interested in attending may call Participant Services at 800-815-0000 (TTY users call 711).

Virtual Meeting, June 7, 2018
2018 PAC Meeting Calendar
Virtual Meeting, March 8, 2018
New York County, December 7, 2017
Virtual Meeting, September 7, 2017
Virtual Meeting, June 8, 2017

New York County, March 23, 2017


Provider Materials

Provider Manual
Non-Participating Provider Waiver of Liability Statement
Part D Authorization Portal

Policy

Privacy Notice
Non-Discrimination Notice

H0811_GN654_2018 Website_Approved
Last updated 7/9/18