Enrollment FAQs

Request a Member ID Card

Order Over-the-Counter Supplies

Appoint Representation

File a Grievance

File an Appeal

Get a Temporary Supply of Prescription Drugs

Submit a Healthcare Claim or Bill

Disenroll from Brand New Day

Find Community Based Resources

Participate in the Rewards Plus Program

Mail Order Rx and Extra Help

Medication Therapy Management Program

Extra Help to Pay for Prescription Drugs

Prior-Authorization, Coverage Determination, and Exceptions

Prescription Drug Transition Policy

Step Therapy

File an Appeal for Part D Prescription Drugs

Plan Documents (ANOC, EOC and Summary of Benefits)

Health Education

Medicare Resources

Member Resource Guide 2022 (English | Spanish | Chinese | Korean | Vietnamese)

Multi-Language Interpreter Services

Wider Circle Termination Notice for HMO C-SNP Plans (English | Spanish | Chinese | Korean | Vietnamese)

Wider Circle Termination Notice for HMO and Dual Plans (English | Spanish | Chinese | Korean | Vietnamese)

Non-Discrimination Notice

Out-of-Network Coverage Rules

Part C Pre-Authorizations, Organizational Determination, Appeals, and Grievances

Privacy Practices for Protected Health Information (PHI)

Provider/Pharmacy Search

Utilization Management

Medicare Plan Ratings / Medicare STAR Ratings 2022 (English | Spanish | Chinese | Korean | Vietnamese)

Winter Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Spring Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Summer Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Fall Newsletter (English | Spanish | Chinese | Korean | Vietnamese)

2022 Over-the-Counter (OTC) Order Form
(English | Spanish | Chinese | Korean | Vietnamese)

Appeal Form
(English | Spanish | Chinese | Korean | Vietnamese)

Appointment of Representative Form (English | Spanish)

Authorization for Disclosure of Protected Health Information

Enrollment Forms (2022

MedImpact Direct Order Forms
(English | Spanish | Chinese | Korean | Vietnamese)

Grievance Form
(English | Spanish | Chinese | Korean | Vietnamese)

Authorization Service Request Form (English | Spanish)

Benefit Highlights

2022 Health Risk Assessment (HRA)
(English | Spanish | Chinese | Korean | Vietnamese)

To complete an Electronic HRA click here

DeltaCare USA Dental
Medicare Fee Schedule | Fee Schedule for Dual Eligibles

Western Dental
Medicare Fee Schedule | Fee Schedule for Dual Eligibles