Member Resources

The Member Resources page is categorized list of documents and links to provide you with information related to your benefits and the health plan. Important forms, instructions and general information is also available below. 


This plan is available to anyone who has both Medical Assistance from the State and Medicare. Co-pays may vary based on the level of Extra Help you receive. Please contact the plan for further details.

For information on benefits, co-payments, co-insurance and deductibles please refer to the Summary of Benefits and Evidence of Coverage.  A list of any out-of-network coverage rules can also be found in the Summary of Benefits.

The benefit information provided is a brief summary, not a complete description of benefits.  For more information contact the plan. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. 

You must continue to pay your Medicare Part B premium. If you are a full dual eligible enrollee your monthly Part B premium is paid for by the State.

This information is available for free in other languages. Please contact our Customer Care Center at (877) 874-3930 for additional information. Esta información esta disponible gratis en otros idiomas. Favor de llamar al Centro de Atención al Cliente al (877) 874-3930 para información adicional.

Clicking a category below will expand the selection to reveal documents, forms and links.