Communications
New Member Mailing # 1 pdf Confirmation of Enrollment Letter 10 calendar days post CMS notice of acceptance of enrollment
pdf Evidence of Coverage (sample)
pdf LIS rider (if applicable)
pdf ID card & card carrier
New Member Mailing # 2 pdf Material Enclosure Letter (sample) 10 calendar days post CMS notice of acceptance of enrollment
pdf Comprehensive Formulary (sample)
pdf Pharmacy Directory (sample)
pdf Mail Order Form, Instruction Sheet & BRE
pdf Appointment of Representative Form
pdf Claim Form & BRE
COB letter
(this replaces COB survey)
pdf Coordination of Benefits Letter (sample) Annually, 1st quarter
CVS ExtraCare Card Mailing pdf CVS ExtraCare Card Letter Monthly
pdf CVS ExtraCare Card