2023 Member Materials

You can get this information for free in other languages. Call 1-833-LAC-DSNP (1-833-522-3767) (TTY: 711). The call is free. You can also ask for this information in other formats, such as audio CD, Braille or large print.

Annual Notice of Change

Below are our Annual Notice of Change documents in eleven languages.
(Updated 02/27/2023)

List of Covered Drugs (Formulary)

Below are our Formulary documents in eleven languages.
(Updated 05/01/2023)

Member Handbook

Below are our Member Handbook documents in eleven languages.
(Updated 02/27/2023)

Notice of Privacy Practices

Below are our Notice of Privacy Practices documents in eleven languages.
(Updated 09/19/2022)

Provider/Pharmacy Directory

Below are our Provider/Pharmacy Directory documents in eleven languages.
(Updated 05/22/2023)

Volume 1

Volume 2

Summary of Benefits

Below are our Summary of Benefits documents in eleven languages.
(Updated 09/28/2022)

Low-Income Subsidy (LIS)

(Updated 10/10/2022)

Notice of Nondiscrimination

Below is our Notice of Nondiscrimination in eleven languages.
(Updated 09/20/2022)

Individual Enrollment Request Form to Enroll in a Medicare Advantage Plan (Part C)

(Updated 10/24/2022)

Language and Interpreter Taglines

Below is our Language and Interpreter Taglines in eleven languages.
(Updated 10/01/2022)

Authorized Representative Form

This authorization allows the named representative to act on your behalf in a number of ways. Please review the instructions on the form for full details.
(Updated 03/28/2023)