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MEMBER MATERIALS, FORMS, RESOURCES & GUIDELINES

Learn more about your GlobalHealth Medicare Advantage Plan plan and benefits. Download the latest member materials below. All materials shown are available in printed versions. If you need a printed version, please contact Customer Care and a copy will be mailed to you. You may also request a copy to be mailed to you by logging into your Member Portal .

Materials for all Plan Options

Unless otherwise stated, all plans are HMO and require referrals from your Primary Care Physician.

Select Benefit Year and Benefit Plan to view plan materials

2025
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2025
Plan Year Documents
English Spanish

Please select a plan from the dropdowns to view documents.

No plans are available for the year 2024.

Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
2025 Comprehensive Formulary (Updated 08/01/2025) 2025 Comprehensive Formulary (Updated 08/01/2025)
2025 Formulary Changes (Updated 08/01/2025)  
2025 Step Therapy Criteria (Updated 10/01/2024)  
2025 Prior Authorization Criteria (Updated 08/01/2025)  
2025 Part B Prior Authorization Criteria (Updated 05/07/2025)  
2025 Medicare Part B Step Therapy List  
2025 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 08/01/2025) GlobalHealth Pharmacy Directory (Updated 08/01/2025)
Most Current List of participating Pharmacies
C-SNP Plans - Pre-Enrollment Qualification Assessment Tool  
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
2025 Comprehensive Formulary (Updated 08/01/2025) 2025 Comprehensive Formulary (Updated 08/01/2025)
2025 Formulary Changes (Updated 08/01/2025)  
2025 Step Therapy Criteria (Updated 10/01/2024)  
2025 Prior Authorization Criteria (Updated 08/01/2025)  
2025 Part B Prior Authorization Criteria (Updated 05/07/2025)  
2025 Medicare Part B Step Therapy List  
2025 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 08/01/2025) GlobalHealth Pharmacy Directory (Updated 08/01/2025)
Most Current List of participating Pharmacies
C-SNP Plans - Pre-Enrollment Qualification Assessment Tool  
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
2025 Comprehensive Formulary (Updated 08/01/2025) 2025 Comprehensive Formulary (Updated 08/01/2025)
2025 Formulary Changes (Updated 08/01/2025)  
2025 Step Therapy Criteria (Updated 10/01/2024)  
2025 Prior Authorization Criteria (Updated 08/01/2025)  
2025 Part B Prior Authorization Criteria (Updated 05/07/2025)  
2025 Medicare Part B Step Therapy List  
2025 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 08/01/2025) GlobalHealth Pharmacy Directory (Updated 08/01/2025)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
2025 Comprehensive Formulary (Updated 08/01/2025) 2025 Comprehensive Formulary (Updated 08/01/2025)
2025 Formulary Changes (Updated 08/01/2025)  
2025 Step Therapy Criteria (Updated 10/01/2024)  
2025 Prior Authorization Criteria (Updated 08/01/2025)  
2025 Part B Prior Authorization Criteria (Updated 05/07/2025)  
2025 Medicare Part B Step Therapy List  
2025 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 08/01/2025) GlobalHealth Pharmacy Directory (Updated 08/01/2025)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
2025 Comprehensive Formulary (Updated 08/01/2025) 2025 Comprehensive Formulary (Updated 08/01/2025)
2025 Formulary Changes (Updated 08/01/2025)  
2025 Step Therapy Criteria (Updated 10/01/2024)  
2025 Prior Authorization Criteria (Updated 08/01/2025)  
2025 Part B Prior Authorization Criteria (Updated 05/07/2025)  
2025 Medicare Part B Step Therapy List  
2025 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 08/01/2025) GlobalHealth Pharmacy Directory (Updated 08/01/2025)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
2025 Comprehensive Formulary (Updated 08/01/2025) 2025 Comprehensive Formulary (Updated 08/01/2025)
2025 Formulary Changes (Updated 08/01/2025)  
2025 Step Therapy Criteria (Updated 10/01/2024)  
2025 Prior Authorization Criteria (Updated 08/01/2025)  
2025 Part B Prior Authorization Criteria (Updated 05/07/2025)  
2025 Medicare Part B Step Therapy List  
2025 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 08/01/2025) GlobalHealth Pharmacy Directory (Updated 08/01/2025)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
2025 Comprehensive Formulary (Updated 08/01/2025) 2025 Comprehensive Formulary (Updated 08/01/2025)
2025 Formulary Changes (Updated 08/01/2025)  
2025 Step Therapy Criteria (Updated 10/01/2024)  
2025 Prior Authorization Criteria (Updated 08/01/2025)  
2025 Part B Prior Authorization Criteria (Updated 05/07/2025)  
2025 Medicare Part B Step Therapy List  
2025 Part B Transition Policy  
GlobalHealth Pharmacy Directory (Updated 08/01/2025) GlobalHealth Pharmacy Directory (Updated 08/01/2025)
Most Current List of participating Pharmacies
Summary Of Benefits Resumen De Beneficio
Evidence Of Coverage (Updated 05/09/2025) Evidencia De Cobertura (Updated 05/09/2025)
Annual Notice Of Changes Aviso Anual De Cambios
All Plans - 2025 Enrollment Request Form  
All Plans - 2025 Pre-Enrollment Checklist  
For OMES EGID enrollment forms, please contact the employer group  
Benefit Overview Plan Year 2025 Benefit Overview Plan Year 2025
Star Ratings - 2025 Star Ratings - 2025
Multi-language Insert Multi-language Insert
All Plans - Additional Documents
Provider Directory
English Spanish
Provider Directory - Updated 12/01/2024 Directorio de Proveedores - Updated 12/01/2024
Provider Directory January 2025 - Updated 01/03/2025 Directorio de Proveedores Actualizaciones de enero 2025
Provider Directory February 2025 - Updated 02/03/2025 Directorio de Proveedores Actualizaciones de febrero 2025
Provider Directory March 2025 - Updated 03/03/2025 Directorio de Proveedores Actualizaciones de marzo 2025
Provider Directory April 2025 - Updated 04/10/2025 Directorio de Proveedores Actualizaciones de abril 2025
Provider Directory May 2025 - Updated 05/03/2025 Directorio de Proveedores Actualizaciones de mayo 2025
Provider Directory June 2025 - Updated 06/03/2025 Directorio de Proveedores Actualizaciones de junio 2025
Provider Directory July 2025 - Updated 07/07/2025 Directorio de Proveedores Actualizaciones de julio 2025
Provider Directory August 2025 - Updated 08/03/2025 Directorio de Proveedores Actualizaciones de agosto 2025
Pharmacy
English Spanish
Medicare Part D Prescription Claim Form
Prescription Drug Mail Order Form Prescription Drug Mail Order Form
Prescription Drug Transition Policy  
Medication Therapy Management (MTM) Program Information  
Utilization Management Program  
Request for Medicare Prescription Drug Coverage Determination Form Request for Medicare Prescription Drug Coverage Determination Form
Request for Medicare Prescription Drug Appeal (Redetermination) Form Request for Medicare Prescription Drug Appeal (Redetermination) Form
Request for Prescription Drug Prior Authorization Exception Request for Prescription Drug Prior Authorization Exception
Request for Prescription Drug Quantity Limits Request for Prescription Drug Quantity Limits
Request for Prescription Drug Step Therapy Exception Request for Prescription Drug Step Therapy Exception
Request for Prescription Drug Reimbursements  
Over the Counter Benefit – Place Order  
Extra Help to pay your plan premium or prescriptions (LIS)  
Pharmacy FAQ
English Spanish
What is a Formulary  
What is a Late Penalty for Part D  
Legal Documents
Member Reimbursement
English Spanish
Direct Member Reimbursement Form - Online Form - Routine Vision Exam/Eyewear  
Direct Member Reimbursement Form - Mail In Form - Routine Vision Exam/Eyewear  
Direct Member Reimbursement Form - Other Medical Services Direct Member Reimbursement Form - Other Medical Services
Extra Documents
English Spanish
Best Available Evidence (BAE) - from CMS  
Quality Improvement Program  
Remember to Take Your Medication  
2025 Health Risk Assessment (HRA)  
Smart Wallet Approved Items  
Member Health Tools
English Spanish
Blood pressure log  
Member Incentive Program  
Member Newsletters
English Spanish
August 2025 Issue  
May 2025 Issue  
February 2025 Issue