Plan Documents

Review your plan documents to make sure you get the most from your health plan. You can also find additional plan documents in your TrueCare MyLife account.

Member Handbook/Evidence of Coverage

Your Navigate Member Handbook/Evidence of Coverage is a guide to your health care benefits. It tells you how our plan works, the covered services you get, services that are not included and your rights and responsibilities.

• Navigate Member Handbook/Evidence of Coverage (updated 10/1/2025)

Summary of Benefits

The Summary of Benefits includes your covered benefits and any limitations. This is only a summary. View your Evidence of Coverage for a full list of benefits.

• Navigate Summary of Benefits

Benefits at-a-Glance

Use the Navigate Benefits at-a-Glance  (updated 10/1/2025) to put your benefits to work for you! This is only a guide. View your Evidence of Coverage for a full explanation of your benefits.

Annual Notice of Change

The Annual Notice of Change outlines the changes to your benefits for the next plan year.

• Navigate ANOC for members moving from DSNP to HIDE
• Navigate ANOC for members moving from MMP to HIDE

Provider/Pharmacy Directory

The Find a Doctor tool has our most up-to-date list of network providers. You will find office hours, whether the office is on a bus line, if the provider is seeing new patients and more. The Find a Pharmacy tool has the most updated list of pharmacies.

• Provider/Pharmacy Directory (json) (coming soon)

Prior Authorization List

Prior Authorization is the approval that may be needed before you get a service. The service must be medically necessary for your care. Your provider will take care of this for you. View the full list of services that need prior authorization (coming soon). Your provider can submit a request for a prior authorization using the Prior Authorization Request Form (coming soon).

Prescription Drug Benefit Documents

• List of Covered Drugs (Formulary)– A list of all drugs covered under your plan.
  • List of Covered Drugs (Formulary) (Coming soon)
• Notice of Formulary Changes – Throughout the year, changes may occur to drugs on our formulary. Check this list to view the updates. 2025 Notice of Formulary Changes coming soon.
  • Notice of Formulary Changes (Coming soon)
• Preferred Diabetic Supply List – We cover diabetic testing supplies. This list has the preferred products.
  • Preferred Diabetic Supply List(Coming soon)
• Prior Authorization Criteria – For certain drugs, your doctor will need to contact us before you can fill your prescription.
  • Prior Authorization Criteria (Coming soon)
  • Medicare Part B Drug Prior Authorization Policies (Coming soon)
• Step Therapy Criteria – For certain drugs, we require you to first try another drug to treat your medical condition before we will cover the drug your physician initially prescribed.
  • Step Therapy Criteria (Coming soon)
• Drug Transition Policy (Coming soon) – Learn about our policy for potentially covering a drug you currently take that is not listed in our formulary.
• Coverage Determination Request Form(Coming soon) – If you believe you are entitled to payment or coverage on a certain drug, you can request a coverage determination by completing this form.
• Coverage Redetermination Request Form(Coming soon) – If you are unsatisfied with the outcome of a coverage determination request, you can file an appeal using the redetermination form.