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2018 Plan Documents

Here are the important documents for your plan.


  • Evidence of coverage - details about medical, dental and prescription drug coverage and costs

  • Annual notice of change - notification of changes to your plan

  • Summary of benefits - description of benefits

  • Provider and pharmacy directory - lists our doctors, hospitals, pharmacies and other health care providers in your plan's network. A searchable directory can be found here.

  • Plan ratings - Star ratings of 2018 Medicare Advantage plans

Passage Plan 1 (HMO)


Evidence of coverage (EOC)

Summary of benefits

Provider and pharmacy directory

Choice Plan 1 (HMO)


Evidence of coverage (EOC)

Summary of benefits

Provider and pharmacy directory

Choice Plan 2 (HMO)


Evidence of coverage (EOC)

Summary of benefits

Provider and pharmacy directory

Flex Plan 1 (HMO-POS)


Evidence of coverage (EOC)

Summary of benefits

Provider and pharmacy directory

Flex Plan 2 (HMO-POS)


Evidence of coverage (EOC)

Summary of benefits

Provider and pharmacy directory

Flex Plan 3 (HMO-POS)


Evidence of coverage (EOC)

Summary of benefits

Provider and pharmacy directory

Other related forms


Plan rating

Long enrollment form

Formulario de solicitud de inscripcion

Short enrollment form

Multi-language interpreter services

Direct debit form

LIS premium sheet

ConnectiCare Medicare Advantage guide


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Last Update 11/26/2018

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