Medicare Advantage Forms & Information
Navigating Medicare can feel overwhelming, but UCLA Health Medicare Advantage Plan is here to simplify the process. Whether you're looking for essential health plan forms, detailed information, or trusted resources, we have you covered. Our comprehensive provider directory ensures that you can easily find the right healthcare providers to meet your needs. Explore our resources to stay informed and empowered on your healthcare journey.
Download Our Medicare Advantage Resources
To request a hard copy of the forms and resources on this page, please contact Member Services at 1-833-627-8252 (833-MAP-UCLA). TTY users should call 711. The Member Services team will mail a hard copy to you within 3 days of the request.
Evidence of Coverage Principal Plan (coming soon)
Evidence of Coverage Prestige Plan (coming soon)
CMS Star Ratings (coming soon - see disclaimer for details)
Additional Resources
- Advance Healthcare Directive Form
- LEP Reconsideration
- Rights & Responsibilities Upon Disenrollment
- For more information please refer to Chapter 10 Section 1 to Section 5 in the Evidence Of Coverage document at EOCPrincipal (for Principal Plan members) or EOCPrestige (for Prestige Plan members)
- CMS Redetermination Form
- Coverage Determination Request
- Disaster & Emergency Policy
- Drug Formulary (Spanish)
- Enrollment Form – Spanish (fillable)
- Prescription Drug Transition Policy
- Reconsideration Form