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2012 MetroPlus Medicare Plan Specific Materials
The Summary of Benefits shows some of the features of the plans such as benefits, cost-sharing and rules for using these benefits. For more detailed information, please refer to the Evidence of Coverage (EOC).
Summary of Benefits
Advantage, Select and Partnership In Care Summary of Benefits - English Spanish
Platinum Summary of Benefits English Spanish
Evidence of Coverage
The Evidence of Coverage (EOC) provides a detailed explanation of your coverage, what we must do, your rights, and what you must do as a member of our plan.
Advantage Evidence of Coverage
English Spanish
Select Evidence of Coverage English Spanish
Partnership In Care Evidence of Coverage English Spanish
Platinum Evidence of Coverage English
Spanish
Medicaid Advantage Handbook
The Medicaid Advantage Handbook provides a detailed explanation of Medicaid coverage for MetroPlus Select Plan members.
Medicaid Advantage Handbook English Spanish
Annual Notice of Change
The Annual Notice of Changes (ANOC) for 2012 gives you a summary of changes to your benefits and costs for the next year. These changes took effect on January 1, 2012.
Advantage ANOC English Spanish
Select ANOC English Spanish
Partnership in Care ANOC English Spanish
Platinum ANOC English Spanish
Provider/Pharmacy Directory - This is a directory of all the pharmacies and providers who deliver covered services to MetroPlus members. (coming soon)
2012 MetroPlus Medicare Extra Help Monthly Plan Premium Chart - The amount of your monthly plan premium depends on if you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs.
2012 Prescription Drug Coverage
Plan Ratings
2012 MetroPlus Comprehensive Formulary
2012 MetroPlus Abridged Formulary (coming soon)
Drug Utilization Management Information
Prior Authorization
Quantity Limits
Step Therapy
Forms
Medicare Prescription Drug Coverage Determination Form
Medicare Prescription Drug Coverage Redetermination Form
H0423_MKT0908v5 CMS APPROVED 10142011
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