Get to Know Your Member Documents
Each year, you receive a lot of documents related to your health plan coverage and benefits. We want to make sure you understand these documents so you can make smart healthcare decisions.
Learn more about what each document is, and when you might need to use it.
What is this?
- An easy to-read guide that explains your plan’s benefits, or the services and items that your plan covers. This document breaks down each benefit included in your plan, including listing what is covered, how many visits are included, copay amounts*, and more.
When should I use it?
- Refer to this document when you have a question about a specific benefit or how much it might cost.
Where can I find it?
- If you need a copy, log in to your secure member portal or contact Member Services.
What is this?
- This letter explains any changes to your health plan for the following plan year. This could include changes to your monthly premium, pharmacy network, or benefits.
When should I use it?
- Reference this document when reviewing plans for the upcoming year.
Where can I find it?
- You will receive this document in the fall of each plan year. If you need a copy, log in to your secure member portal or contact Member Services.
What is this?
- A list of prescription drugs covered by your plan. Your formulary is also called a drug list.
When should I use it?
- You can use your drug list to see what drugs are covered by your plan and what medications may require prior authorization.
Where can I find it?
- If you need a copy, log in to your secure member portal or contact Member Services.
What is this?
- You receive your Welcome/Welcome Back Kit after your confirmed enrollment in your health plan. It is your first look at your plan and benefits and gives an overview of:
- Dental, vision, and hearing benefits
- Pharmacy benefits
- Additional benefits such as telehealth, fitness, and 24/7 Nurse Line
- How to access your secure member portal
- How to set up mail order pharmacy
- How to pay your premium
- How to use your coverage
When should I use it?
- Use this booklet to get the most out of your coverage and when you have questions about your plan benefits.
Where can I find it?
- This document is mailed to you at the beginning of each plan year, or before your plan’s effective date.
What is this?
- Your “Evidence of Coverage” (EOC), also called the Member Handbook (MH), tells you how to get your prescription drugs. It explains what is covered, and what you pay as a member of the plan. It's a legal document that provides full, complete information about how your Medicare plan works.
When should I use it?
- Refer to this document when you need more details about what your health plan covers, how it works, or how much you will need to pay for services.
Where can I find it?
- If you need a copy, log in to your secure member portal or contact Member Services.
What is this?
- Your Explanation of Benefits (EOB) is sent to you after you visit the doctor, receive medical care or use your prescription benefits. It is not a bill. It breaks down the costs that the doctor billed to the health plan, how much the health plan paid, and any costs you may need to pay.
When should I use it?
- You can keep your Explanation of Benefits for your records. You can reference your EOB to track how much you have paid towards your deductible and maximum out-of-pocket costs.
Where can I find it?
- The doctor, medical facility or pharmacy you visited will mail you an Explanation of Benefits after your visit. If you did not receive one, you can contact the office and ask them to send you a new copy.
What is this?
- Your Member ID card is the key to getting the care you need. Your Member ID card lets your provider know how to bill your health plan. Carry it with you everywhere you go. Your card contains basic information, like your health plan member number. The back of your Member ID card will list important numbers for quick reference.
When should I use it?
- You will need to show your Member ID card whenever you visit a pharmacy, doctor’s office, hospital, or clinic. If you are dually enrolled in Medicare and Medicaid, you will need to carry both cards as they each serve a unique purpose.** Use your Member ID card to find important numbers, such as member services and 24/7 Nurse Line.
Where can I find it?
- Your member ID card is mailed to you before your plan’s effective date. You can find a digital version of your card by logging in to your secure member portal. Once logged in, you can view or print a new ID card.
**Some dual eligible special needs plans (D-SNP) use a single ID card for both Medicare and Medicaid.
Commonly Asked Questions
Your Member ID Card, Welcome Kit, and Benefit Overview brochure should arrive prior to your effective date. If you do not receive your materials, let us know during your Welcome Call as we can send another set your way.
If you need a copy of a document, you have a few options:
Log in to your secure member portal
- You will need to create an account if you have not already done so.
- Find documents, view or print your Member ID card and more.
Contact Member Services
- We are happy to help. Call Member Services at the number listed on the back of your Member ID card. TTY users dial 711.
- From April 1 to September 30, we are available Monday through Friday 8 a.m. to 8 p.m.
- From October 1 to March 31, we are available every day from 8 a.m. to 8 p.m.
Yes, you can sign up for paperless documents to get digital documents instead. You’ll get an email when there’s a new document ready for you to view in your member portal.
- Log in to your member portal
- Under “Communications Preferences” select “Email” instead of “Mail.”
Here, you can also opt in to receive text messages. Under “Text Notifications” select “Yes” and input your mobile phone number to start getting helpful plan updates.