Plan Material and Forms

Plan Material and Forms.

On this page, you will find downloadable documents for this year’s Community Health Choice (HMO D-SNP) plan.

Questions?

October 1 – March 31, 8:00 am to 8:00 pm, 7 days a week and April 1 through September 30, Monday through Friday, 8:00 am to 8:00 pm.

Pre-enrollment Checklist.

In this Medicare checklist, we outline the seven steps you’ll want to check off your to-do list before deciding what best fits your Medicare needs and how to properly become a Medicare beneficiary.

2020 Summary of Benefits.

The Summary of Benefits outlines your plan benefits for the current calendar year.

Please click on the link below download a PDF copy.

2020 Evidence of Coverage.

The Evidence of Coverage (EOC), along with your enrollment form, is Community’s contract with you. These documents explain your rights, benefits, and responsibilities as a Member of Community Health Choice (HMO D-SNP).

Provider Directory.

The Provider Directory outlines your plan’s network of primary care physicians, specialists, hospitals, skilled nursing facilities, outpatient mental health Providers, DMEs, dental, and vision Provider contacts.

Please call Member Services if you would like a hard copy of the directory mailed to you.

How to Cancel or Leave the Plan.

You can change health plans only at certain times during the year. From October 15 – December 7, you can join, switch or drop a Medicare health or drug plan for the following year. 

How to Cancel or Leave the Plan

Pharmacy Directory.

The Pharmacy Directory provides a list of your plan’s network pharmacies.

Please call Member Services if you would like a hard copy of the directory mailed to you.


H9826_IT_10045_092919_M Last updated September 30, 2019