Forms & Documents
Instructions on How to Get Covered Services During a Disaster.
Medicare Plans
HealthAdvantage Plan (HMO) 001
HealthAdvantage Plan (HMO) 012
HealthAdvantage Plan (HMO) 013
HealthAdvantage Plus (HMO) 017
HealthAdvantage Plus (HMO) 018
HealthAdvantage Plus (HMO) 020
MediSun Extra (HMO D-SNP) 019
MediSun Plus (HMO D-SNP) 016
VitalCare (HMO C-SNP) 021
VitalCare (HMO C-SNP) 022
Member Notices and Updates
Member Announcements
Plan Changes and Disenrollment Information
Plan Changes and Disenrollment
Prescription Drug Benefits
Prescription Drug Benefits
- 2025 Catalog Over-the-Counter (OTC) Items
- 2025 Creole Part D Transition Policy
- 2025 Creole Prescription Drug Formulary – updated 09/23/2024
- 2025 HealthSun Prior Authorization - updated 12/23/2024
- 2025 OTC Order Form - All Plans
- 2025 Part D Transition Policy
- 2025 Prescription Drug Formulary – updated 09/23/2024
- 2025 Step Therapy Criteria - updated 10/03/2024
- 2025 Therapy Management Medication (MTM) Program
- Appointment of Representative Form
- B vs. D Coverage Determination Request Form
- CMS Medicare Prescription Drug Coverage Determination Request Form
- Lost, Damaged, or Stolen Medication Form
- Medicare Prescription Payment Plan Participation Request Form
- Medication Sync Request Form
- Part D Reimbursement Request Form
- Personal Medication List Form
- Prescription Coverage Determination Request Form
- Vacation Supply Form