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Enrollment Form

Stand-Alone Prescription Drug Plan Enrollment Form

HMO Pharmacy Directory

PPO Pharmacy Directory

Stand-Alone Prescription Drug Plan Pharmacy Directory

Summary of Benefits

These documents include a partial list of covered services. You’ll find what you’ll pay with a Health Alliance Medicare Advantage plan compared to what you pay with Original Medicare.

HMO 20 (HMO)/HMO 20Rx (HMO)

PPO 10 (PPO)/PPO 10Rx (PPO)

PPO 30 (PPO)/PPO 30Rx (PPO)

Basic Stand-Alone Prescription Plan (PDP)

Evidence of Coverage

These documents include a complete list of covered services and what you’ll pay.

HMO 20 (HMO)

HMO 20Rx (HMO)

PPO 10 (PPO)

PPO 10Rx (PPO)

PPO 30 (PPO)

PPO 30Rx (PPO)

Basic Stand-Alone Prescription Drug Plan (PDP)

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Basic Stand-Alone Prescription Drug Plan (PDP) EOC

Basic Stand-Alone Prescription Drug Plan (PDP) Summary of Benefits

Stand-Alone Prescription Drug Plan (PDP) Enrollment Form

Stand-Alone Prescription Drug Plan Pharmacy Directory 

Medicare Part D Abridged Formulary

Transition letter

All contents copyright (c) 2011 Health Alliance Medical Plans. All rights reserved. Every effort has been made to ensure that this information is accurate. It is not intended to replace the legal source. In case of any discrepancy between this information and the legal source, the legal source will govern in all cases.

Last Updated October 1, 2011

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CMS Approved 10/15/2011