Medicare/DSNP Request for mailed plan documents EMBED SFMC

Medicare/D-SNP Plan Documents:

You can download and print your 2024 plan documents by clicking on the PDFs on the previous webpage or view them in your Priority Health member account. If you would like to request copies to be printed and mailed to you with the address we have for you on file, please enter the following information below. By requesting a hard copy of your 2024 plan documents, you will receive future plan documents by print and mail.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Contract ID (found on the back of your member ID Card): *This question is required. Format: 000000000-00

4. Please reenter your Contract ID: *This question is required. Format: 000000000-00

5. Please select the following plan documents you would like to receive in the mail: *This question is required.

Evidence of Coverage (EOC): Your EOC is a document that explains exactly what your plan contract includes and what it does not include, how to access health care, what services require prior authorization from Priority Health, and much more.
Formulary: Your Formulary is a list of all of the prescription drugs your plan will cover and the level of coverage.
Provider Pharmacy Directory (PPD): Your PPD lists the providers and pharmacies in our network.

Evidence of Coverage (EOC)
Formulary
Provider Pharmacy Director (PPD)

6. The PPD will be a directory based on the address you have on file under your contract number. This will be a list of primary care providers within a 10-mile radius and specialists within a 25-mile radius. *This question is required.

Yes, this directory will meet my needs

Please note: You can also refer to our Find a Doctor tool to see a list of providers in your area.

If you would like a directory based on your region or for another address, please call our Customer Service team at the phone number on the back of your ID Card.

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