Documents for 2018 Georgia plans
- Plan Details (Summary of Benefits and Evidence of Coverage)
- 2018 Welcome Booklet ( English | Español )
Forms
- Authorization for Disclosure of Protected Health Information ( English | Español )
- Appointment of Representative Form
- 2018 Enrollment Form ( English | Español )
- EFT/ACH Form for Premium Billing ( English | Spanish )
- Health Assessment ( English | Spanish )
Appeals and Grievances
Drug Coverage
- Part D Coverage Determinations, Exceptions, Grievances, and Appeals
- Prescription Drug Transition Policy
- Request for Medicare Prescription Drug Coverage Determination
- Request For Redetermination Of Medicare Prescription Drug Denial
Reference
- Notice of Privacy Practices
- How to Disenroll from Clover
- Multi-language Interpreter Services
- 2018 Medicare Plan Ratings ( English | Español )
- Provider Directory
- Out-of-network Coverage Rules
- Utilization Management
- Member Claims Submission