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.


Call 1.833.276.8306
(TTY users should call 711)

October 1 to 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.

On certain holidays your call will be handled by our automated phone system.

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.

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.

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 October 4, 2021.

Why Choose Community?

As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.

“I always tell people to choose Community Health Choice. I tell them it’s the best health insurance they will ever be with.”
– Chandolyn
Member of Community Health Choice