Cal MediConnect member materials
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| Name | English | Español | Tiếng Việt | 中文 | Tagalog |
|---|---|---|---|---|---|
| Advance Health Care Directive Form | Link | Link | Link | Link | Link |
| 2020 Annual Notice of Changes (ANOC) | Link | Link | Link | Link | Link |
| 2021 Annual Notice of Changes (ANOC) | Link | Link | Link | Link | Link |
| Appointment of Representative (AOR) | Link | Link | Link | Link | Link |
| Best Available Evidence—CMS Policy | Link | ||||
| Denti-Cal Provider List | Link | ||||
| 2020 Durable Medical Equipment (DME) List | Link | Link | Link | Link | Link |
| 2021 Durable Medical Equipment (DME) List | Link | Link | Link | Link | Link |
| Language Assistance Services | Link | Link | Link | Link | Link |
| 2020 List of Covered Drugs (Formulary) | Link | Link | Link | Link | Link |
| 2021 List of Covered Drugs (Formulary) | Link | Link | Link | Link | Link |
| 2020 Prior Authorization Requirements | Link | ||||
| 2021 Prior Authorization Requirements | Link | ||||
| 2020 List of Drugs Requiring Step Therapy | Link | ||||
| 2021 List of Drugs Requiring Step Therapy | Link | ||||
| Medicare/Medi-Cal—Update your Information | Link | Link | Link | Link | Link |
| Member Grievance Form | Link | Link | Link | Link | Link |
| 2020 Member Handbook | Link | Link | Link | Link | Link |
| 2021 Member Handbook | Link | Link | Link | Link | Link |
| Member Rights and Responsibilities | Link | Link | Link | Link | Link |
| Notice of Nondiscrimination | Link | Link | Link | Link | Link |
| Notice of Privacy Practices | Link | Link | Link | Link | Link |
| Part D Coverage Determination Request | Link | ||||
| Part D Prescription Drug Claim Form | Link | ||||
| Personal Medication List | Link | Link | Link | Link | Link |
| 2020 Provider and Pharmacy Directory | Link | Link | Link | Link | Link |
| 2021 Provider and Pharmacy Directory | Link | Link | Link | Link | Link |
| Quality Improvement Program Description | Link | ||||
| Request for Redetermination of Part D Drug Denial | Link | Link | Link | Link | Link |
| 2020 Summary of Benefits | Link | Link | Link | Link | Link |
| 2021 Summary of Benefits | Link | Link | Link | Link | Link |
| Vision Service Plan (VSP) Doctor Directory | Link | Link | Link | Link | Link |