Important Forms and Documents

Here you’ll find forms and documents relating to your Medicare plan. If you have any questions or are unable to find what you’re looking for, contact us.

Please choose the type of form you need from the following list. Note: the Summary of Benefits, Evidence of Coverage and Annual Notice of Changes documents included below are for HAP individual Medicare Advantage plan members only. If you receive coverage through a group or employer, please contact us for more information.

HAP medicare member

Manage your Medicare benefits and view personalized plan information

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HAP and Henry Ford

Our connection works for your benefit.
 

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Prescription Home Delivery

Save yourself time and money. Set up mail order for medications you take regularly.

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Health Alliance Plan (HAP) has HMO, HMO C-SNP, HMO-POS, and PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP), HAP Medicare Complete Assist (PPO D-SNP), and HAP CareSourceTM MI Coordinated Health (HMO D-SNP) are Medicare health plans with a Medicare contract and a contract with the Michigan Medicaid Program that provides benefits of both programs to enrollees. Enrollment depends on contract renewals.