Publications and Forms

The following publications and forms are for plan members. All publications below are applicable to the plan year indicated. If you need a publication or form that is not listed below, please contact Member Services. If you would like a printed copy of any of the documents below, please contact Member Services.

2019 Plan Publications:

2019 Summary of Benefits
2019 Quality and Performance Ratings (Every year, Medicare evaluates plans based on a 5-star rating system.)
2019 Annual Notice of Changes (ANOC)
2019 Evidence of Coverage
2019 Comprehensive Formulary (effective January 1, 2019; last updated August 28, 2018)
2019 Prescription Drug Prior Authorization Criteria (effective January 1, 2019)
2019 Prescription Drug Step Therapy Criteria (effective January 1, 2019)

2018 Plan Publications:

2018 Summary of Benefits
2018 Quality and Performance Ratings (Plan performance Star Ratings are assessed each year and may change from one year to the next.)
2018 Annual Notice of Changes (ANOC)
2018 Evidence of Coverage
2018 Comprehensive Formulary (effective December 1, 2018; last updated November 20, 2018)
2018 Prescription Drug Prior Authorization Criteria (effective December 1, 2018)
2018 Prescription Drug Step Therapy Criteria (effective December 1, 2018)

Provider and Pharmacy Directories

Search online using our Network Provider/Facility/Pharmacy Search application
Provider and Part B Pharmacy Directory (last updated September 28, 2018)
Part D Pharmacy Directory (last updated September 28, 2018)

Other Publications and Forms

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.

H5852_4006 2019 101518

PHP, California