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.
Summary of Benefits
View Summary of Benefits
Evidence of Coverage
Directories
Prescription Drug Documents
View Prescription Drug Documents
- You will never pay more than $2100 for your total out of pocket cost, no matter how high the price is on the finder
- Real-time benefit information can be found after searching for a drug and clicking on the “Click here” in the green banner that appears on the page
- You will never pay more than $2100 for your total out of pocket cost, no matter how high the price is on the finder
- Real-time benefit information can be found after searching for a drug and clicking on the “Click here” in the green banner that appears on the page
Additional Resources
View Forms
If you prefer to fill out the Continuity of Care Form electronically or to view the form in an alternative language click here.
View Additional Benefits
View Additional Documents and Resources
Rights & Responsibilities Upon Disenrollment For more information please refer to Chapter 10 Section 1 to Section 5 in the Evidence of Coverage document at EOC Principal Plan or EOC Prestige Plan for members.