Member Materials

On this page, you’ll find important documents related to your MCC of VA (HMO SNP) plan. Click the links below to download each document.

2020
Summary of Benefits

A summary of what we cover and what you pay. It doesn’t list every service we cover or every limitation or exclusion. For a complete list of covered services and exclusions, refer to your Evidence of Coverage.

2020
Evidence of Coverage

Your Medicare health benefits and services and prescription drug coverage as a member of MCC of VA (HMO SNP).

2020
Provider and Pharmacy Directory

A list of MCC of VA (HMO SNP)’s current network of providers and pharmacies.

2020
Formulary

Information about the drugs covered in this plan. This formulary was updated on 10/01/2019.

2020
Notice of Privacy Practices

Describes how medical information about you may be used and disclosed, and how you can get access to this information. Please read this notice carefully.

2020
LIS Rider

Describes the extra help you get paying for your prescription drugs.

2020
LIS Premium Summary

Describes your monthly plan premium if you get extra help paying for your prescription drugs.