Medicare Advantage Forms & Information
Navigating Medicare can feel overwhelming, but UCLA Health Medicare Advantage Plan is here to simplify the process. Whether you're looking for essential health plan forms, detailed information, or trusted resources, we have you covered. Our comprehensive provider directory ensures that you can easily find the right healthcare providers to meet your needs. Explore our resources to stay informed and empowered on your healthcare journey.
Download Our Medicare Advantage Plan Documents
To request a hard copy of the forms and resources on this page, please contact Member Services at 1-833-627-8252 (833-MAP-UCLA). TTY users should call 711. The Member Services team will mail a hard copy to you within 3 days of the request.
Additional Resources
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- Advance Healthcare Directive Form
- Appeals and Grievances Form
- Appointment of Representative
- CMS Redetermination Form
- Complex Care Management (CCM) Referral Form
- Continuity of Care Form
- Exceptions Request Form
- LEP Reconsideration
- Prior Authorization Request Form
- Prescription Drug Coverage
- Determination Request
- Reconsideration Form
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- Organization Determination
- Rights & Responsibilities Upon Disenrollment For more information please refer to Chapter 10 Section 1 to Section 5 in the Evidence Of Coverage document at EOCPrincipal (for Principal Plan members) or EOCPrestige (for Prestige Plan members)
- DME Supplier
- LIS Premium Summary Chart – Prestige Plan
- Transparency in Healthcare