2016 Benefits & Resources

Summary of Benefits
Annual Notice of Change
Evidence of Coverage

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 Step Therapy Protocols
Part D Prior Authorization Criteria
Pharmacy Quality Assurance
Medication Management Therapy Program
Medication Safety
Personal Medication List
National Coverage Determinations (NCD)
Grievances, Appeals, Organization and Coverage Determinations   
Pharmacy Directory
Dental Directory
Locate a Provider
Provider Directory: New York Queens Richmond Suffolk Kings Nassau Bronx
Request Provider or Pharmacy Directory by Mail

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


Last Updated: 12/22/2015