On this page, you can find important documents related to your Senior Whole Health of New York health plan. Click the links below to download each document.
2022 Annual Materials
Annual Notice of Changes (ANOC): Describes changes to your SWH plan coverage, costs or service area.
Summary of Benefits: a summary of what we cover and what you pay. For a complete list of covered services and exclusions, refer to your Evidence of Coverage.
Evidence of Coverage (EOC): your Medicare health benefits and services and prescription drug coverage as a member of Molina Medicare Complete Care.
2022 Provider & Pharmacy Directory
Pharmacy & Prescription Drug Materials
LIS Premium Summary Chart: This chart explains your monthly plan premium if you get Extra Help paying for your prescription drugs.
Formulary (List of Covered Drugs): a list of drugs covered by our plan.
Senior Whole Health Drug Transition Policy
Medicare Part D Coverage Determination Request Form (download and mail or fax form)
Drugs Requiring Prior Authorization
Search the formulary drug list here
Search for a pharmacy here
2022 Member Information
2021 Medicare Star Ratings: The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure the experiences Medicare beneficiaries have with their health plan.
Notice of Privacy Practices: This document explains the steps Molina takes to protect your Personal Health Information (PHI).
Notice of Nondiscrimination: This document explains our policies on nondiscrimination.
Multi-Language Interpreter Services: This document explains how to get help if you speak languages other than English.