Documentos para planes del 2020 en Arizona
Here you can find additional details about Clover's plans
Forms
-
Authorization for the disclosure of protected health information ( English | Spanish )
- Appointment of a representative form
- Continuity of Care Form
- Encuesta de Evaluación de Salud
- 2020 Registration Form ( English | Spanish )
- EFT / ACH form for premium billing ( English | Spanish )
Appeals and complaints
Drug coverage
- Exceptions, claims, appeals and coverage determinations in Part D
- Prescription Drug Transition Policy
- Medicare prescription drug coverage determination request
- Medicare prescription drug denial redetermination request