Health Plans Documents
Access forms, documents, and resources for all Medicare Advantage plans.
Sort by Resource Type
Find the Documents you Need
Choose your plan on the left to see all the documents related to it. You can also select specific document types to see only those ones.
Clinical Coverage Criteria References
When Medicare does not fully define coverage for a service through statute, regulation, National Coverage Determinations, or Local Coverage Determinations, we use clinical coverage criteria based on current evidence, treatment guidelines, and clinical literature. These criteria comply with CMS requirements and are publicly available.
EasyCare
EasyCare Plus
Total
Click on the link and please refer to the PDF under “Other Documents” titled: “Healthplex Dental Claim Review Guidelines (Comprehensive & Limited Plans)”
EasyCare
EasyCare Plus
Total
Medical Necessity and Other Clinical Coverage Criteria (Coming Soon)
EasyCare
EasyCare Plus
Total
Outpatient Physical, Occupational, and Speech Therapy Coverage Guideline
Download PDF: