The links below provide important information and documents for Nascentia Health Plus members
If you have any questions, please call our Member Service Department at 1-888-477-4663 (TTY: 711).
- Annual Notice of Change
- Appointment of Representative Form (pdf)
- Appointment of Representative Instructions (pdf)
- Coverage Determination Request Form (pdf)
- Drug Formulary
- Electronic Material Notice (pdf)
- Enrollment Application (pdf)
- Enrollment Instructions (pdf)
- Evidence of Coverage (EOC)
- Nascentia Health Plus Frequently Asked Questions (pdf)
- Grievances & Appeals
- HIPAA Release of Information
- LIS Premium Summary Chart (pdf), updated 10/01/2022
- Medication Therapy Management (MTM) Letter and Personal Medication List (pdf)
- Medication Therapy Management (MTM) Program Requirements
- Medicare Complaint Form
- Medicare Enrollment Help
- Medicare Plan Finder
- Medicare Star Rating (pdf)
- Member Rights & Responsibilities
- Nondiscrimination Notice (pdf)
- Pharmacy Directory
- Pharmacy Transition Process (pdf)
- Prior Authorization Requirements (pdf), updated 10/01/2022
- Prior Authorization Request Form (pdf)
- Privacy Policy
- Provider Directory
- Redetermination Request Form (pdf)
- Summary of Benefits – Nascentia Dual Advantage (D-SNP) (pdf), updated 03/15/2023
- Summary of Benefits – Nascentia Skilled Nursing Facility (I-SNP) (pdf), updated 10/01/2022
Last Updated on March 17, 2023
