CHRISTUS Health Medicare Complete (HMO) / Medicare Plus (HMO)

2025 Documents

2025 Annual Notice of Change 

ENGLISH

SPANISH

2025 Evidence of Coverage 

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SPANISH

2025 Summary of Benefits 

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SPANISH

Provider & Pharmacy Directory 

Provider Search Tools

Provider & Pharmacy Directory

Medicare Advantage Complete and Plus

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SPANISH

24-Hour Nurse Line 
CHRISTUS Health, Medicare Advantage (HMO) members have access to a toll-free 24-hour nurse line. Call the number 844-581-3174 to speak with a registered nurse at any time, day or night. If you are experiencing a medical emergency, please dial 911.
Compliance Policies 
Dental Reimbursement 

If you choose to go out-of-network for your dental care, you may be reimbursed for your treatment. Complete the patient and subscriber information on the Delta Dental Claims Form.

Mail the completed form and a copy of the dentist’s Statement of Treatment (or detailed receipt) to:
Delta Dental Insurance Company
PO Box 1809
Alpharetta, GA 30023

The Statement of Treatment or detailed receipt must include:

  • Name, address, and complete phone number of dentist
  • Date each service was performed
  • Description, procedure code, and fee of each service performed
  • List of affected teeth
  • Total cost of services performed
  • Dentist’s National Provider Identifier (NPI)
  • Dentist’s Tax Identification Number (TIN)
  • State license number
  • Specialty code

Important note: If the Statement of Treatment or similar document you receive from your dentist is missing any of the information listed above, please enter it on the claim form. A dental office staff member can provide you with the dentist and treatment information.

Be sure to make a copy of the completed claim form and the dentist’s Statement of Treatment or detailed receipt for your records.


 

Enrollment & Disenrollment Forms 

Ways to Enroll

We provide three enrollment options: Online, Application (fax or mail) and through Medicare.gov.

Enroll online - Enroll Now

2025 Enrollment Applications (fax or email)

Disenrollment Applications

Authorization to Disclose Personal Information 
Fitness Reimbursement Forms 

Please note that your 2025 fitness benefit is offered through the Silver&Fit Healthy Aging and Exercise program and does not require reimbursement.

Please visit SilverandFit.com to register for your account and to find one of the thousands of fitness centers near you.

Medical Reimbursement Form 
Appeals and Grievances 
Pharmacy 

Forms

To review our covered prescriptions, please download, or search our online searchable formulary.

Prior Authorization 
Appointment of Representative 

 

Scope of Appointment 

H1189_WEB25MM3012_M | Last Updated 07/14/25