Important Plan Documents
Below is a list of all required documentation associated with 2021 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.
Select a topic from the list below to view information:
- Annual Notice of Change – Essence Advantage
- Appointment of Representative
- Evidence of Coverage – Essence Advantage
- Grievances and Appeals Booklet
- HIPAA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Prescription Drug Coverage Redetermination Form
- Prescription Drug Formulary – Essence Advantage
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Star Ratings
- 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
- HIPAA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Prescription Drug Coverage Redetermination Form
- Prescription Drug Formulary – Essence Advantage Plus
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Star Ratings
- 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
- HIPAA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Prescription Drug Coverage Redetermination Form
- Prescription Drug Formulary – Essence Advantage Select
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Star Ratings
- Step Therapy Requirements/Criteria
- Summary of Benefits – Essence Healthcare
- Annual Notice of Change – (Boone County)
- Appointment of Representative
- Evidence of Coverage – (Boone County)
- Grievances and Appeals Booklet
- HIPAA Authorization Form
- Low Income Subsidy Information
- Part D Drug Transition Supply Policy
- Prescription Drug Coverage Determination Form
- Prescription Drug Coverage Redetermination Form
- Prescription Drug Formulary – Essence Advantage (Boone)
- Prior Authorization Requirements
- Provider Directory – Essence Healthcare
- Request for Medicare Prescription Drug Coverage Determination (Secure Online Form)
- Request for Medicare Prescription Drug Coverage Redetermination Form (Secure Online Form)
- Star Ratings
- Step Therapy Requirements/Criteria
- Summary of Benefits – (Boone County)
Ready to get the all-in-one coverage of an Essence Healthcare plan?
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