Plan Documents
Important documents for your plan.
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Documents for Maryland
Advantage PPO
- Annual Notice of Changes (PPO)
- Annual Notice of Changes (PPO Primary)
- Annual Notice of Changes (Plus PPO)
- Summary of Benefits (PPO & HMO)
- Evidence of Coverage (PPO Primary)
- Evidence of Coverage (PPO Plus)
- Evidence of Coverage (PPO)
- Over the Counter (OTCHS) Catalog – English | Spanish
- Prescription Drug Formulary
- PPO LIS Premium Summary Chart – English | Spanish
- 2025 Advantage MD (PPO) Star Ratings – English | Spanish
Advantage HMO
- Annual Notice of Changes (HMO)
- Summary of Benefits (PPO & HMO)
- Evidence of Coverage (HMO Tribute)
- Evidence of Coverage (HMO)
- Over the Counter (OTCHS) Catalog – English | Spanish
- Prescription Drug Formulary
- 2025 Advantage MD (HMO) Star Ratings – English | Spanish
Advantage D-SNP (HMO)
Documents for Virginia
Advantage Select (HMO)
- Annual Notice of Changes Select (HMO)
- Summary of Benefits Select (HMO)
- Evidence of Coverage Select (HMO)
- Over the Counter (OTCHS) Catalog – English | Spanish
- Prescription Drug Formulary
- 2025 Advantage MD Select (HMO) Star Ratings – English | Spanish
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