Below is a list of all required documentation associated with 2022 plan-year benefits in PDF format.
Simply click to view, download or print a document.
Select an Essence Healthcare plan below to view applicable documents.
- Annual Notice of Change – Essence Advantage
- Appointment of Representative
- Evidence of Coverage – Essence Advantage
- Grievances and Appeals Booklet
- HIPPA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Prescription Drug Coverage Redetermination Form
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Prescription Drug Formulary – Essence Advantage
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Star Rating Sheet
- Calificaciones por Estrellas
- Step Therapy Requirements/Criteria
- Summary of Benefits – Essence Healthcare
- Annual Notice of Change – Essence Advantage Plus
- Appointment of Representative
- Evidence of Coverage – Essence Advantage Plus
- Grievances and Appeals Booklet
- HIPPA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Prescription Drug Coverage Redetermination Form
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Prescription Drug Formulary – Essence Advantage Plus
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Star Rating Sheet
- Calificaciones por Estrellas
- Step Therapy Requirements/Criteria
- Summary of Benefits – Essence Healthcare
- Annual Notice of Change – Essence Advantage Select
- Appointment of Representative
- Evidence of Coverage – Essence Advantage Select
- Grievances and Appeals Booklet
- HIPPA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Prescription Drug Coverage Redetermination Form
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Prescription Drug Formulary – Essence Advantage Select
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Star Rating Sheet
- Calificaciones por Estrellas
- Step Therapy Requirements/Criteria
- Summary of Benefits – Essence Healthcare
- Appointment of Representative
- Evidence of Coverage
- Grievances and Appeals Booklet
- HIPPA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Prescription Drug Coverage Redetermination Form
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Prescription Drug Formulary
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Star Rating Sheet
- Calificaciones por Estrellas
- Step Therapy Requirements/Criteria
- Summary of Benefits
- Annual Notice of Change – (Boone County)
- Appointment of Representative
- Evidence of Coverage – (Boone County)
- Grievances and Appeals Booklet
- HIPPA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Prescription Drug Coverage Redetermination Form
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Prescription Drug Formulary – Essence Advantage (Boone)
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Star Rating Sheet
- Calificaciones por Estrellas
- Step Therapy Requirements/Criteria
- Summary of Benefits – (Boone County)
- Summary of Benefits
- Resumen de Beneficios
- 福利摘要
- Evidence of Coverage
- Evidencia de Cobertura
- 承保范围的证据
- Star Rating Sheet
- Calificaciones por Estrellas
- Provider Directory
- Directorio de Proveedores
- 提供商目录
- Annual Notice of Change
- Annual Notice of Change (San Mateo)
- Aviso Anual de Cambio
- Aviso Anual de Cambio (San Mateo)
- 年度变更通知
- 年度变更通知 (San Mateo)
- Drug Formulary
- Formulario de Medicamentos
- 药物配方
- Low Income Subsidy Information
- Información sobre Subsidios por Bajos Ingresos
- 低收入补贴信息
- Summary of Benefits
- Resumen de Beneficios
- 福利摘要
- Evidence of Coverage
- Evidencia de Cobertura
- 承保范围的证据
- Star Rating Sheet
- Calificaciones por Estrellas
- Provider Directory
- Directorio de Proveedores
- 提供商目录
- Annual Notice of Change
- Aviso Anual de Cambio
- 年度变更通知
- Drug Formulary
- Formulario de Medicamentos
- 药物配方
- Low Income Subsidy Information
- Información sobre Subsidios por Bajos Ingresos
- 低收入补贴信息
- Summary of Benefits
- Resumen de Beneficios
- 福利摘要
- Evidence of Coverage
- Evidencia de Cobertura
- 承保范围的证据
- Star Rating Sheet
- Calificaciones por Estrellas
- Provider Directory
- Directorio de Proveedores
- 提供商目录
- Annual Notice of Change
- Aviso Anual de Cambio
- 年度变更通知
- Drug Formulary
- Formulario de Medicamentos
- 药物配方
- Low Income Subsidy Information
- Información sobre Subsidios por Bajos Ingresos
- 低收入补贴信息
- Summary of Benefits
- Resumen de Beneficios
- 福利摘要
- Evidence of Coverage
- Evidencia de Cobertura
- 承保范围的证据
- Star Rating Sheet
- Calificaciones por Estrellas
- Provider Directory
- Directorio de Proveedores
- 提供商目录
- Annual Notice of Change
- Aviso Anual de Cambio
- 年度变更通知
- Drug Formulary
- Formulario de Medicamentos
- 药物配方
- Low Income Subsidy Information
- Información sobre Subsidios por Bajos Ingresos
- 低收入补贴信息
Ready to get the all-in-one coverage of an Essence Healthcare plan?
We make it easy for you to get the information you need, when and how you need it.
Request your FREE Information Kit
Download your FREE Medicare Advantage info kit or request a copy by mail.
Schedule a one-on-one consultation
Get all your questions answered in a one-on-one appointment with a licensed Medicare advisor.
Attend a Medicare Seminar
Learn more about Essence Healthcare plans at one of our FREE local or online Medicare seminars.
Talk with a licensed Medicare advisor
Call anytime to discuss your options with a local, licensed Essence Healthcare advisor.
