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Important forms and documents

Here you’ll find forms relating to your Medicare plan. If you have any questions, or if you’re unable to find what you’re looking for, contact us

Please choose the type of form you need from the following list. Please note, the Summary of Benefits, Evidence of Coverage and Annual Notice of Changes documents included below are for HAP individual Medicare plan members only. If you receive coverage through a group or employer, please contact us for more information.

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Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Empowered Duals (HMO SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.