Health Plans Documents

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Member Notices
Total
Language Assistance Notice
Download PDF:
All Languages
Total
Notice of Non-Discrimination
Download PDF:
EnglishSpanishChinese
OTC & Grocery Catalogs
EasyCare Plus Total
Over-the-Counter (OTC) and Grocery Program Catalog
2025 Plans
English/Spanish/Chinese
2026 Plans
English/Spanish/Chinese
EasyCare
Over-the-Counter (OTC) Program Catalog
2025 Plan
English/Spanish/Chinese
2026 Plan
English/Spanish/Chinese
Plan Star Ratings
EasyCare EasyCare Plus Total
Plan Star Ratings
2025 Plans
EnglishSpanishChinese
2026 Plans
EnglishSpanishChinese
Prescription Drug Copay Table
EasyCare Plus
Prescription Drug Copay Table
2026 Plan
EnglishSpanishChinese
EasyCare
Prescription Drug Copay Table
2026 Plan
EnglishSpanishChinese
Prior Authorization Request Forms
EasyCare EasyCare Plus Total
Medicare Prior Authorization Requirements
Download PDF:
Medicare Prior Authorization Requirements
EasyCare EasyCare Plus Total
New York State Medicaid Prior Authorization Request Form for Prescriptions
Download PDF:
NYS Medicaid Prior Authorization Request Form
Total
Pre-Authorization Request Form for VNS Health Managed Long Term Care Plans
Download PDF:
Pre-Authorization Request Form