Medicare resources and forms

Evidence of Coverage

Your EOC explains what your Medicare plan covers, how much you can expect to pay for services and more.. It is a legal document that provides full, complete information about how your Medicare plan works.

Your EOC also includes:

• Information about in- and out-of-network coverage rules
• Your rights and responsibilities as a member
• Your rights and responsibilities if you disenroll
• Our rights and responsibilities if you disenroll

HealthPartners UnityPoint Health Align (PPO) EOC

HealthPartners UnityPoint Health Symmetry (PPO) EOC

Annual Notice of Changes

Your Annual Notice of Changes (ANOC) describes changes to your plan's coverage, costs or administration for the upcoming year. These changes are effective starting in January.

HealthPartners UnityPoint Health Align (PPO) ANOC

HealthPartners UnityPoint Health Symmetry (PPO) ANOC

The Summary of Benefits outlines what each plan covers and what you’ll pay for those services. The booklet doesn’t list everything that is covered by your plan, or every limitation or exclusion. For a full list of covered services, see the Evidence of Coverage above.

HealthPartners UnityPoint Health Summary of Benefits

If you have concerns about the care you received, you can get more info on filing an appeal or grievance or requesting a determination.

Learn more about appeals and grievances

You can also learn about appointing a representative and completing the form. In addition, you can take a look at the Medicare complaint form and see info from the Medicare Ombudsman Center.

HealthPartners UnityPoint Health has a strong network of doctors, clinics and pharmacies in your area that you can see for a lower cost.

Find care and pharmacies in our Medicare Advantage network

Using your plan’s out-of-network benefit, you can also see any doctor that accepts Medicare.

• HealthPartners UnityPoint Health star ratings

Get one-on-one help from a pharmacist to be sure you’re getting the most out of your medications. MTM is available at no cost with any HealthPartners UnityPoint Health Medicare plan.

Learn more about medication therapy management

• Diabetes supplies
• Prior authorization list and Part B step therapy list

This list contains prior authorization (PA) and step therapy requirements for network providers for certain services and Part B drugs.

We have many Medicare Part D resources available to help you understand the prescription drug coverage that comes with your HealthPartners UnityPoint Health Medicare plan

Each Medicare prescription drug plan has its own list of covered drugs, known as a formulary. Our pharmacists and doctors update the drug lists each year based on the latest medication and treatment information, which helps us include the safest and most effective prescription drugs available.

Additional Part D resources include:

• Print or save the HealthPartners UnityPoint Health formulary (PDF)
• Formulary change notices
• Prior authorization criteria
• Prior authorization form
• Step therapy criteria
• Medicare Extra Help program
• Transitional medication policy
• Best available evidence policy on CMS.gov

Stay updated on National Coverage Determinations (NCDs) from the Centers for Medicare and Medicaid (CMS).

Learn more about Medicare coverage updates

Use these Medicare resources to find more information about:

• Getting care during a disaster
• Nondiscrimination notice and language assistance