Information Last Updated: 12/14/2020
Dental
Vision
24 Hour Doctor & Nurse Advice Line
Acupuncture & Chiropractor
Gym Membership
Rides to the Doctor
Hearing Aid
Over-The-Counter Supplies
Weight Loss and Weight Management
Request a Member ID Card
Order Over-the-Counter Supplies
Appoint Representation
File a Grievance
File an Appeal
Make an Appeal (Redeterminations)
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
Plan Documents (ANOC, EOC and Summary of Benefits)
Health Education
Medicare Resources
Member Resource Guide (English | Spanish | Chinese | Korean | Vietnamese)
Multi-Language Interpreter Services
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 ( English | Spanish | Chinese | Korean | Vietnamese )
2021 Over-the-Counter (OTC) Order Form (English | Spanish | Chinese | Korean | Vietnamese)
Appeal Form
Appointment of Representative Form (English | Spanish)
Authorization for Disclosure of Protected Health Information
Enrollment Form (2020)
Grievance Form
Authorization Service Request Form (English | Spanish)
Benefit Highlights
Health Risk Assessment (HRA) English | Spanish | Chinese | Korean | Vietnamese
To complete an Electronic HRA click here
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