Medicare Advantage Generations/Generations Plus

2021 Plan Year

• Generations Annual Notice of Change (ANOC)- New Mexico (PDF)
  
• Generations Plus Annual Notice of Change (ANOC)- New Mexico (PDF)
• Generations Annual Notice of Change (ANOC)- Texas (PDF)
• Generations Plus Annual Notice of Change (ANOC) - Texas (PDF)
• Generations Annual Notice of Change en Espanol (ANOC)- New Mexico (PDF)
  
• Generations Plus Annual Notice of Change en Espanol (ANOC)- New Mexico (PDF)
• Generations Annual Notice of Change en Espanol (ANOC)- Texas (PDF)
• Generations Plus Annual Notice of Change en Espanol (ANOC) - Texas (PDF)

2022 Plan Year

English

• Generations Annual Notice of Change (ANOC) - New Mexico (PDF)
  
• Generations Plus Annual Notice of Change (ANOC) - New Mexico (PDF)
• Generations Annual Notice of Change (ANOC) - Texas (PDF)
• Generations Plus Annual Notice of Change (ANOC) - Texas (PDF)

Spanish

• Generations Annual Notice of Change en Espanol (ANOC) - New Mexico (PDF)
  
• Generations Plus Annual Notice of Change en Espanol (ANOC) - New Mexico (PDF)
• Generations Annual Notice of Change en Espanol (ANOC) - Texas (PDF)
• Generations Plus Annual Notice of Change en Espanol (ANOC) - Texas (PDF)

• Appointment of Representative Form (PDF)
• Appointment of Representative Form en Espanol (PDF)

• Consent Form (PDF)

• Annual Attestations from FDRs (PDF)
• Annual Compliance Program Effectiveness Assessment- Medicare Advantage (PDF)
• Breach Notification PHI- Reporting Guideline (PDF)
• Code of Ethics (PDF)
• Code of Ethics for CHRISTUS Health Plan Louisiana (PDF)
• Communications Regarding Regulatory Changes (PDF)
• Compliance Training and Education (PDF)
• Corrective Action (PDF)
• Fraud, Waste, and Abuse (PDF)
• Monitoring and Auditing (PDF)
• Non-Discrimination Notice (PDF)
• Non-Retaliation Policy (PDF) 

Ways to Enroll

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

Enroll online - Enroll Now

2023 Enrollment Applications (fax or email)

• 2023 Short Enrollment Application (PDF)
• 2023 New Mexico Enrollment Application (PDF)
• 2023 Enrollment Application Northeast Texas (PDF)
• 2023 Enrollment Application Southeast Texas  (PDF)
• 2023 South Central and East Texas Medicare Expansion Counties (PDF)

2022 Enrollment Applications (fax or email)

• 2022 Short Enrollment Application (PDF)
• 2022 Short Enrollment Application en Espanol (PDF)
• 2022 New Mexico Enrollment Application (PDF)
• 2022 New Mexico Enrollment Application en Espanol (PDF)
• 2022 Enrollment Application Northeast Texas (PDF)
• 2022 Enrollment Application Southeast Texas  (PDF)
• 2022 Enrollment Application Northeast Texas en Espanol (PDF)
• 2022 Enrollment Application Southeast Texas en Espanol (PDF)
• Individual Enrollment Request Form en Espanol (PDF)
• Late Enrollment Penalty Reconsideration Notice (PDF)
• Medicare Part D Late Enrollment Penalty Reconsideration Notice (PDF)

2022 Disenrollment Applications 

• Disenrollment Request Form (PDF)
• Disenrollment Request Form en Espanol (PDF)
  
  

2022 Plan Year

• Generations Evidence of Coverage (EOC) - New Mexico (PDF)
• Generations Evidence of Coverage (EOC) en Espanol- New Mexico (PDF)
• Generations Plus Evidence of Coverage (EOC) en Espanol- New Mexico (PDF)
• Generations Plus Evidence of Coverage (EOC) - New Mexico (PDF)
• Generations Evidence of Coverage (EOC) - Texas (PDF)
• Generations Evidence of Coverage (EOC) en Espanol- Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) - Southeast Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) - Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) en Espanol -Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) en Espanol - Southeast Texas (PDF)

2021

• New Mexico Fitness Reimbursement Form (PDF)
• Texas Fitness Reimbursement Form (PDF)

2022

• New Mexico Fitness Reimbursement Form (PDF)
• Northeast Texas Fitness Reimbursement Form (PDF)
• Southeast Texas Fitness Reimbursement Form (PDF)

• Grievance and Appeal Request Form (PDF)

Learn more about our Grievance and Appeals Process 

• Home Delivery Order Form (PDF)
• Mail Order Form (PDF)
• Part D Coverage Determination Request Form (PDF)
• Rx Claim Form - English (PDF)
• Rx Claim Form - Spanish (PDF)

• Prior Authorization Request Form (PDF)

Provider Search Tools

• Online Searchable Provider Directory

Provider & Pharmacy Directory

• 2022 Provider & Pharmacy Directory Texas- English (PDF)
• 2022 Provider & Pharmacy Directory New Mexico- English (PDF)