Medicare Advantage Generations/Generations Plus

2023 Plan Year

Generations

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

Generations Spanish

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

Generations Plus

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

Generations Plus Spanish

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

Guardian English

• Guardian Annual Notice of Change (ANOC) - Southeast Texas (PDF)
• Guardian Annual Notice of Change (ANOC) - New Mexico  (PDF)
• Guardian Annual Notice of Change (ANOC) - Northeast Texas (PDF)

Guardian Spanish

• Guardian Annual Notice of Change (ANOC) - Southeast Texas en Espanol (PDF)
• Guardian Annual Notice of Change (ANOC) - New Mexico en Espanol (PDF)
• Guardian Annual Notice of Change (ANOC) - Northeast Texas en Espanol (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 Short Enrollment Application en Espanol (PDF)
• 2023 New Mexico Enrollment Application (PDF)
• 2023 New Mexico Enrollment Application en Espanol (PDF)
• 2023 Enrollment Application Northeast Texas (PDF)
  
• 2023 Enrollment Application Northeast Texas en Espanol (PDF)
• 2023 Enrollment Application Southeast Texas  (PDF)
• 2023 Enrollment Application Southeast Texas en Espanol; (PDF)
• 2023 Enrollment Application South Central and East Texas Medicare Expansion Counties (PDF)
• 2023 Enrollment Application South Central and East Texas Medicare Expansion Counties en Espanol (PDF)

2023 Disenrollment Applications 

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

 

2023 Plan Year

Generations English

• Generations Evidence of Coverage (EOC) - Northeast Texas (PDF)

Generations Spanish

• Generations Evidence of Coverage (EOC) en Espanol - Texas (PDF)

Generations Plus

• Generations Plus Evidence of Coverage (EOC) - New Mexico (PDF)
• Generations Plus Evidence of Coverage (EOC) - East Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) - Southeast Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) - South Central Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) -  Northeast Texas (PDF)

Generations Plus Spanish

• Generations Plus Evidence of Coverage (EOC) en Espanol - New Mexico (PDF)
• Generations Plus Evidence of Coverage (EOC) en Espanol - East Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) en Espanol  - Northeast Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) en Espanol- Southeast Texas (PDF)
• Generations Plus Evidence of Coverage (EOC) en Espaonol- South Central Texas (PDF)

 

2023

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

• Medical Reimbursement Form

• Grievance and Appeal Request Form (PDF)
• Learn more about our Grievance and Appeals Process
• LEP Reconsideration Request Form
• Appendix 14-Model Part D Late Enrollment Penalty Reconsideration Notice

Forms

• 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)
• Express Scripts Mobile App and Web Access (PDF)
• Registering with Express Scripts (PDF)

 

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

• Prior Authorization Request Form (PDF)

Provider Search Tools

• Online Searchable Provider Directory

Provider & Pharmacy Directory

• 2023 Provider & Pharmacy Directory New Mexico - English (PDF)
• 2023 Provider & Pharmacy Directory Texas - English (PDF) 

2023 Plan Year

Generations

• Generations Summary of Benefits - Northeast Texas (PDF)

Generations Spanish

• Generations Summary of Benefits en Espanol - Northeast Texas (PDF)

Generations Plus

• Generations Plus Summary of Benefits - New Mexico
• Generations Plus Summary of Benefits  - East Texas
• Generations Plus Summary of Benefits - Northeast Texas
• Generations Plus Summary of Benefits - South Central Texas
• Generations Plus Summary of Benefits - Southeast Texas

 

Generations Plus Spanish

• Generations Plus Summary of Benefits en Espanol - New Mexico
• Generations Plus Summary of Benefits en Espanol - East Texas
• Generations Plus Summary of Benefits en Espanol - Northeast Texas
• Generations Plus Summary of Benefits en Espanol - Southeast Texas
• Generations Plus Summary of Benefits en Espanol - South Central Texas

• Scope of Appointment (PDF)