Senior Health Plan Medicare Advantage Plans
Senior Health Plan Silver	Evidence of Coverage Summary of Benefits
Senior Health Plan Platinum	Evidence of Coverage Summary of Benefits
Senior Health Plan Platinum Plus	Evidence of Coverage Summary of Benefits

Use the links below for more information about CommunityCare Senior Health Plan. Vision Providers Behavioral Health Senior Center Member Newsletter Nurse Line Frequently Asked Questions about Senior Health Plan Privacy Notice Transition Policy Information for Employers Preventing Fraud Tip Sheet Medicare Part D Upcoming Changes to the Senior Health Plan Formulary Coverage Decisions Summary of Part D grievance, coverage decisions, and appeals Frequently Asked Questions about Pharmacies and Formularies

Advanced Directive Appointment of Representative Auto Bank Draft Authorization Individual Election Form Medicare Prescription Drug Coverage Determination Request Instructions Model Coverage Determination Request Form Pcp Change Form PHI Authorization Form Prescription Authorization Form Redetermination/Appeal Request Form Request for Disenrollment Short Enrollment Form Working Aged Form

Pharmacy and Prescription Drug Resources

• Mail Order Prescription Drug Program
  Choose from two convenient options. Click here for more mail order prescription information.
• $0 Copay Program
  Zero Copay on Select Generic Formulary Drugs.
• On-line Formulary
  Search for prescription medications that promote clinically useful and cost-effective drug therapy.
• Find a Pharmacy
  Search the most current list of participating Pharmaices.
• Monthly Plan Premiums for People who get Extra Help from Medicare
  If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan. Click here view the low income subsidy premium table.
• Drug Management Programs
  For certain prescription drugs, we have additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. Click here for more information regarding our drug management programs.
• CMS Best Available Evidence Policy
  CMS has created a best available evidence (BAE) policy, which requires sponsors whose plans cover Part D prescription drugs to provide access to those drugs at the correct low-income subsidy (LIS) cost-sharing level when presented with evidence of a beneficiary’s LIS eligibility, even if the sponsor’s system and CMS’s system do not yet reflect that eligibility. Click here to view the Best Available Policy and related resources located on the CMS website.