Plan Documents

Here you'll find a collection of our Massachusetts Medicare plan forms and plan information. Just click on the links below to download the forms you need.

Summary of Benefits

Evidence of Coverage (EOC)

Enrollment Applications

Medicare Advantage

Prescription Coverage

Fitness and Weight Loss Forms

Medex

Privacy

Employer Group retiree coverage varies. Contact your employer's benefits administrator for specific information or, call Member Service at 1-800-200-4255 (TTY: 1-800-522-1254), as follows: from February 15 through September 30, 8:00 a.m. to 8:00 p.m. ET, Monday through Friday, and from October 1 through February 14, 8:00 a.m. to 8:00 p.m. ET, seven days a week.

Can't view PDF documents? Get Adobe Reader