Elderplan Plan Materials

Annual Notice of Change (ANOC)

This tells you about Medicare changes that will impact your current plan benefits or costs.

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Summary of Benefits (SOB)

Provides a snapshot of your plan’s costs, benefits and covered health services.

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Evidence of Coverage (EOC)

Is a detailed guide of what is covered and what is not

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Formularies

Is a list of prescription drugs covered by your health plan.

Use Tier 1 formulary if you are enrolled in:

• Elderplan for Medicaid Beneficiaries (HMO-POS D-SNP)
• Elderplan Advantage for Nursing Home Residents (HMO-POS I-SNP)
• Elderplan Plus Long-Term Care (HMO-POS D-SNP)

Use Tier 5 formulary if you are enrolled in: 

• Elderplan Flex (HMO-POS)
• Elderplan Extra Help (HMO-POS)
• Elderplan Assist (HMO-POS IE-SNP)
• Elderplan Select (HMO-POS I-SNP/IE-SNP)

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Star Ratings

Helps Medicare beneficiaries compare the quality of health and drug plans.

For Elderplan Plus Long-Term Care

For other Elderplan Plans

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LIS Premium Summary

Member Brochures

Member Handbooks

Services Offered at Home

Transportation Brochure

All plan materials, such as your Summary of Benefits and Formulary, are on this website. However, if you prefer to have them emailed to you or mailed to your home, fill out the Secure Member Request Form.

Annual Notice of Change

Summary of Benefits

Evidence of Coverage

Formularies

Elderplan for Medicaid Beneficiaries (HMO D-SNP)
Elderplan Advantage for Nursing Home Residents (HMO I-SNP)
Elderplan Plus Long-Term Care (HMO D-SNP)

Elderplan Flex (HMO)
Elderplan Extra Help (HMO)
Elderplan Assist (HMO IE-SNP)

Star Ratings

For Elderplan Plus Long-Term Care

For other Elderplan Plans

Find a Form

Member Brochures

Member Handbooks

Services Offered at Home

Transportation Brochure