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Plan Materials

Below is the breakdown of service areas between the two Michigan plans offered by Molina Healthcare:

Molina Medicare Complete Care (HMO SNP) H5926-001 – Allegan, Arenac, Barry, Bay, Clare, Genesee, Gratiot, Huron, Kent, Lake, Lapeer, Livingston, Macomb, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Ottawa, Saginaw, Sanilac, Shiawassee, Tuscola, Washtenaw, Wayne

Molina Medicare Complete Care (HMO SNP) H5926-004 – Antrim, Branch, Charlevoix, Crawford, Grand Traverse, Kalkaska, Leelanau, Manistee, Missaukee, Otsego, Roscommon, Wexford

	2020	2021
Notice of Non-Discrimination & Language Assistance (Services)/Aviso de no discriminación y asistencia lingüística (servicios) Language Assistance (Services)/Servicios de asistencia con el idioma
Annual Notice of Change (ANOC) Aviso Anual de Cambios (ANOC)	View PDF Ver PDF	View PDF - H5926-001 Ver PDF - H5926-001
Evidence of Coverage (EOC) Evidencia de cobertura (EOC)	View PDF Ver PDF	View PDF - H5926-001 View PDF - H5926-004 Ver PDF - H5926-001 Ver PDF - H5926-004
Formulary Formulario	View PDF Ver PDF	View PDF Ver PDF
Mail Order Prescription Service Notice Aviso de servicio de prescripción por correo	View PDF Ver PDF	View PDF Ver PDF
OTC Catalog | OTC Product Catalog Addendum Catálogo de Productos OTC | Apéndice del catálogo de productos de venta libreOTC	View PDF | View PDF Ver PDF | Ver PDF	View PDF Ver PDF
Provider/Pharmacy Directory Directorio de proveedores y farmacias	View PDF Ver PDF	View PDF Ver PDF
Summary of Benefits Resumen de beneficios	View PDF Ver PDF	View PDF - H5926-001 View PDF - H5926-004 Ver PDF - H5926-001 Ver PDF - H5926-004
A Simple Guide to your New Benefits Una guia simple para sus nuevos beneficios	View PDF Ver PDF	View PDF - H5926-001 View PDF - H5926-004 Ver PDF - H5926-001 Ver PDF - H5926-004
ID Card Sample Ejemplo de tarjeta de identificación