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 10/01/2024)
List of Covered Drugs (Formulary)
Below are our Formulary documents in eleven languages.
(Updated 10/01/2024)
Member Handbook
Below are our Member Handbook documents in eleven languages.
(Updated 10/01/2024)
Member Guides
Below are our Member Guides documents in eleven languages.
(Updated 10/01/2024)
Notice of Privacy Practices
Below are our Notice of Privacy Practices documents in eleven languages.
(Updated 06/28/2024)
Provider/Pharmacy Directory
Below are our Provider/Pharmacy Directory documents in eleven languages.
(Coming Soon)
Volume 1
- Provider and Pharmacy Directory – English Volume 1 of 2
- Provider and Pharmacy Directory – Spanish Volume 1 of 2
- Provider and Pharmacy Directory – Chinese Volume 1 of 2
- Provider and Pharmacy Directory – Korean Volume 1 of 2
- Provider and Pharmacy Directory – Armenian Volume 1 of 2
- Provider and Pharmacy Directory – Russian Volume 1 of 2
- Provider and Pharmacy Directory – Tagalog Volume 1 of 2
- Provider and Pharmacy Directory – Vietnamese Volume 1 of 2
- Provider and Pharmacy Directory – Farsi Volume 1 of 2
- Provider and Pharmacy Directory – Khmer Volume 1 of 2
- Provider and Pharmacy Directory – Arabic Volume 1 of 2
Volume 2
- Provider and Pharmacy Directory – English Volume 2 of 2
- Provider and Pharmacy Directory – Spanish Volume 2 of 2
- Provider and Pharmacy Directory – Chinese Volume 2 of 2
- Provider and Pharmacy Directory – Korean Volume 2 of 2
- Provider and Pharmacy Directory – Armenian Volume 2 of 2
- Provider and Pharmacy Directory – Russian Volume 2 of 2
- Provider and Pharmacy Directory – Tagalog Volume 2 of 2
- Provider and Pharmacy Directory – Vietnamese Volume 2 of 2
- Provider and Pharmacy Directory – Farsi Volume 2 of 2
- Provider and Pharmacy Directory – Khmer/Cambodian Volume 2 of 2
- Provider and Pharmacy Directory – Arabic Volume 2 of 2
Summary of Benefits
Below are our Summary of Benefits documents in eleven languages.
(Updated 10/01/2024)
Low-Income Subsidy (LIS)
(Updated 10/01/2024)
Notice of Nondiscrimination
Below is our Notice of Nondiscrimination in eleven languages.
(Updated 06/25/2024)
Individual Enrollment Request Form to Enroll in a Medicare Advantage Plan (Part C)
(Updated 10/01/2024)
Attestation of Eligibility
(Updated 10/05/2023)
Notice of Availability
Below is our Notice of Availability in eleven languages.
(Updated 10/01/2024)
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)