Member Resources
CoxHealth Medicare Advantage
Find a Form
Search forms for enrollment claims, prescriptions, and more
Prescription Drug Resources
Learn more about your prescription drugs and the resources to help you.
Appeals and Grievances
For information about how to appeal a coverage determination or express a grievance.
Authorized Representative
Give permission for a person to act on your behalf.
Advance Directive
Use an Advanced Directive to communicate your decisions.
Advance care planning provides an opportunity for you to make decisions about your healthcare in the event of a medical crisis, and to make your choices known in a legal document called an advance directive. An advance directive is a written instruction, such as a living will or durable power of attorney for healthcare, which is recognized under State law and relates to the provision of healthcare when an individual is unable to make healthcare decisions.
CoxHealth Medicare Advantage is committed to upholding advance directives in accordance with State law.
- We document whether or not an individual has executed an advance directive in a prominent part of the individual’s current medical record.
- We maintain and ensure that staff is trained on policies and procedures concerning advance directives with respect to all adult individuals receiving medical care by or through CoxHealth Medicare Advantage.
- We cannot refuse care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive.
- If we cannot implement an advance directive as a matter of conscience, CoxHealth Medicare Advantage will issue a clear and precise statement of this limitation, which must include information that:
- Explains the differences between institution-wide objections based on conscience and those that may be raised by individual physicians,
- Identifies the state legal authority permitting such objection, and
- Describes the range of medical conditions or procedures affected by the conscience decision.
Additional information and education on advance directives and advance care planning is available to the community through online and in-person workshops and materials provided by our partner, CoxHealth, at www.CoxHealth.com.
You have the right to file a complaint about noncompliance with advance directives requirements with the State survey and certification agency.
Disaster & Emergency Policy
If the Governor of Missouri, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in our service area, you can still get medical care and prescription medications from CoxHealth Medicare Advantage.
Generally, during a disaster or emergency, CoxHealth Medicare Advantage will allow you to obtain medical care from out-of-network providers at in-network cost-sharing rates without prior authorization requirements. In cases where payment is required up front for the out-of-network care you may submit a request for reimbursement to the plan.
CoxHealth Medicare Advantage has a national network of pharmacies available to fill prescriptions for medications. If you cannot use a network pharmacy during a disaster, you may be able to fill your prescription drugs at an out-of-network pharmacy. In cases where payment for the cost of the drugs is required at the time the prescription is filled you may submit a request for reimbursement to the plan.
Plan Disenrollment
As enrollment in an MA plan is limited to certain periods, disenrollment is also limited to certain periods: Annual Election Period, Medicare Advantage Open Enrollment Period – January 1- March 31 each year, and Special Election Periods depending on the situation.
During the Annual Election Period (AEP), the Medicare Advantage Open Enrollment Period (MA-OEP)or in a Special Election Period (SEP), if you want to leave your MA plan and don’t want to join another MA plan, you must send a written request to the plan or call 1-800-MEDICARE during the enrollment period.
If you want to switch from one MA plan to another, simply submit an enrollment application to the new plan and once you are accepted, you will be automatically disenrolled from your current plan. Again, in general, you can only make changes such as this during the AEP, MA-OEP or an SEP.
This method of disenrollment also applies to Part D prescription drug coverage. For example, if you are in an MA plan with Part D coverage (MA-PD) and wish to switch to a stand-alone prescription drug plan (PDP), enrolling in a PDP automatically disenrolls you from your previous MA-PD plan, and vice versa.
Member Rights
As a valued member you are entitled to certain rights and services. As a member, there are also responsibilities in your health care. By familiarizing yourself with and following these steps when receiving medical services you can get the most from your coverage.
Optional Self-Referral for Case Management
If you would like a member of our Case Management team to contact you, please complete the information below. Our Case Management nurses can assist you in obtaining optimal medical and pharmacological services for complex medical conditions (such as diabetes, asthma, heart disease).
Case Management services are provided at no cost!
Digital Health Learning
Getting Started with Telehealth
Learn about the benefits of telehealth, how to communicate with a provider using secure messaging, the technology needed to attend a telehealth appointment, and tips for attending a telehealth appointment.
Right Care Right Now
Find the right care for your medical needs. Selecting the best care type can help manage your care and reduce your out-of-pocket costs.
