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2019 Plan Materials
Please see the links below for information about 2019 plans.
2019 Summary of Benefits
Northeast Medicare Advantage (PPO)
Southeast Medicare Advantage (PPO)
NetworkCares (PPO SNP)
NetworkPrime (MSA)
Network Health Medicare Explore (HMO)
2019 Evidence of Coverage
Network PlatinumSelect (PPO)
Network PlatinumChoice (PPO)
Network PlatinumPlus (PPO)
Network PlatinumPlus Pharmacy (PPO)
Network PlatinumPremier (PPO)
Network PlatinumPremier Pharmacy (PPO)
Network Health Medicare Go (PPO)
Network Health Medicare Anywhere (PPO)
NetworkCares (PPO SNP)
NetworkPrime (MSA)
Network Health Medicare Explore (HMO)
2019 Annual Notice of Change
This document explains changes to each plan for the 2019 plan year.
Network PlatinumSelect (PPO)
Network PlatinumPlus (PPO)
Network PlatinumPlus Pharmacy (PPO)
Network PlatinumPremier (PPO)
Network PlatinumPremier Pharmacy (PPO)
Network PlatinumChoice (PPO)
Network Health Medicare Go (PPO)
Network Health Medicare Anywhere (PPO)
NetworkCares (PPO SNP)
NetworkPrime (MSA)
2019 Formulary Documents
Part D Comprehensive Formulary – Open
Part D Comprehensive Formulary – Closed
Prior Authorization Criteria – Open
Prior Authorization Criteria – Closed
Step Therapy Criteria – Open
Step Therapy Criteria – Closed
2019 Pharmacy Directory
2019 Formulary Changes
Open Formulary Negative Changes
Closed Formulary Negative Changes
2019 Delta Dental Plan Certificate of Coverage
Delta Dental Coverage Included with Most* Plans
*Dental coverage is not included with Network PlatinumSelect (PPO), NetworkCares (PPO SNP) or Network Health Medicare Go (PPO).
Delta Dental Rider Coverage
Optional supplemental dental program available to add on to all plans
Delta Dental Coverage for NetworkCares (PPO SNP)
Specific dental coverage for our members that are dual-eligible.
