Welcome to Help
Frequently Asked Questions
Understanding Medicare Plans
Forms and Documents
Member Rewards Forms
Grievances and Appeals Forms
Appointment of Representative Form
Drug Lists and Formularies
Summary of Benefits
Service Area Maps
Low-Income Subsidy Premium Charts
Evidence of Coverage
Health Plan Ratings
Forms and Documents
Are you looking for your plan’s drug list? Do you want to sign up for automatic billing? While we like to make most things easy to manage online, there are some things you'll need to send to us by mail. And sometimes it's nice to be able to print out important plan information. Here's where you'll find your plan's documents and forms.
- Pharmacy Forms
These forms will help you manage your prescription drug coverage.
- Payment Forms
Use this form to have your Medicare Advantage or Part D plan premiums taken out of your bank account.
- Claim Forms
Use these forms to ask us to pay you back for medical expenses, like prescriptions or out-of-network doctors costs.
- Enrollment Forms
Find enrollment forms for our Medicare Advantage, Medigap and PDP plans here.
- Member Rewards Forms
Want to claim member rewards? Fill out these health evaluation, glaucoma, mammogram and diabetes testing forms.
- Grievances and Appeals Forms
Do you need to file a complaint or coverage determination for your Michigan Medicare plan? Fill out these forms, and we'll contact you to help.
- Appointment of Representative Form
Michigan Medicare members can use this form to choose a representative for their medical decisions. Download it here.
- Drug Lists and Formularies
Need to know if your Medicare plan covers a specific prescription drug? You can use the drug list, also called a formulary, to find out.
- Provider Directories
Are you looking for a list of doctors, hospitals and specialists that accept Medicare patients? Use these directories.
- Summary of Benefits
You can use this document to compare it to other plans and see key features, including cost, benefits, deductibles, copays.
- Evidence of Coverage
Your evidence of coverage book is like an instruction manual for your Michigan Medicare Advantage plan. Find yours here.
- Health Plan Ratings
Want to know which Michigan Medicare plans have the best quality? See government ratings to find out which coverage might be best for you.
- Service Area Maps
Want to know where you can get Medicare coverage in Michigan? These service area maps can help.
- Low-Income Subsidy Premium Charts
Learn more about the monthly LIS premiums for Michigan Medicare plans.