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.
List of Covered Drugs (Formulary)
Below are our Formulary documents in eleven languages.
Below are our Member Handbook documents in eleven languages.
Notice of Privacy Practices
Below are our Notice of Privacy Practices documents in eleven languages.
Below are our Provider/Pharmacy Directory documents in eleven languages.
Summary of Benefits
Below are our Summary of Benefits documents in eleven languages.
Low-Income Subsidy (LIS)
Notice of Nondiscrimination
Below is our Notice of Nondiscrimination in eleven languages.
Individual Enrollment Request Form to Enroll in a Medicare Advantage Plan (Part C)
Language and Interpreter Taglines
Below is our Language and Interpreter Taglines in eleven languages.
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.