Important plan documents
The following documents provide important information on services and benefits to help you make an informed decision about enrolling.
All-in-One Medicare Advantage Decision Guide
Annual Notice of ChangeAnnual Notice of Change Aspire Health Advantage (HMO) PDF | Spanish (en español PDF)Annual Notice of Change Aspire Health Plus (HMO-POS) PDF | Spanish (en español PDF)Annual Notice of Change Aspire Health Value (HMO) PDF | Spanish (en español PDF)Annual Notice of Change Aspire Health Group Plus (HMO-POS) PDF
Aspire Health privacy notice
Care in an emergency or disaster
Getting medical care & prescription drugs in disaster or emergency areas
If the Governor of California, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in Monterey County, you can still get medical care and prescription medications from Aspire Health Plan.
Generally, during a disaster or emergency, Aspire Health Plan will allow you to obtain medical care from out-of-network providers at in-network cost-sharing rates without prior authorization requirements. In cases where payment is required up front for the out-of-network care you may submit a request for reimbursement to the plan.
Aspire Health Plan has a national network of pharmacies available to fill prescriptions for medications. If you cannot use a network pharmacy during a disaster, you may be able to fill your prescription drugs at an out-of-network pharmacy. In cases where payment for the cost of the drugs is required at the time the prescription is filled you may submit a request for reimbursement to the plan.
For more information on how to obtain needed care and medications during a disaster or emergency please call the Aspire Health Plan customer service team toll free at 855-570-1600(TTY users call 711), 8 am to 8 pm PST Monday through Friday (except certain holidays) from April 1 through September 30 and 8 am to 8 pm PST seven days a week for the period of October 1 through March 31.
Choose to share your health Information
We are committed to ensuring your health information is safe, while giving you the flexibility to have a family member, friend or loved one – your “representative” – help make decisions on your behalf. State and federal law requires different forms to be used depending on the actions you want your representative to take on your behalf. We’ve outlined the purpose of each of these forms below.
Want your representative to access your benefits, your claims and/or your bills?
Use the Authorization for Use or Disclosure of Health Information.
You should know:
- This form doesn’t override a Power of Attorney (POA). Don’t complete this form if you have a valid POA.
- You need to complete a separate form, if you need help filing an initial request for coverage, a grievance or appeal.
- This form is valid as long as you are a health plan member
- You have the right to revoke this document at any time
Want your representative to help you file an initial coverage request, grievance or appeal?
Use the Appointment of Representative form.Appointment of Representative information PDF | Nombramiento de un Representante Spanish (en español PDF)
- This form only allows your representative to assist you with initial coverage requests, grievances or appeals.
- Your doctor can make a coverage request and file certain appeals without being your representative.
- This form is only valid for one year.
- The form should be signed by both you and the individual you would like to represent you.
- Once you have completed the form, you must submit that form via fax for mail to the applicable fax number or address listed above before we can talk to your representative.
- You have the right to revoke this document at any time
Already have a Power of Attorney (POA)? Make sure it’s Valid
A valid POA must:
- Name your agent and your relationship to the agent
- State when it becomes effective (e.g., “immediate”) and how long it lasts
- Include the right to revoke at any time
- Be properly signed AND notarized or witnessed
Claim reimbursement request form
Enhanced benefits - dental, vision and hearing
Aspire Health Plan provides comprehensive medical and pharmacy benefits, including preventive care and screenings for all our Medicare Advantage plans. If you’re looking to enhance your coverage we offer optional supplemental benefits. We have two packages to meet your needs. For an additional monthly premium, you can add dental vision, hearing, transportation and post discharge meals to any one of our three plans.
Option A – $44.90 additional premium per month includes:
Option B – $49.90 additional premium per month includes:
- Transportation – 10 additional rides
- 14 home delivered meals, post discharge
For a complete listing of all the benefits:
Enrollment instructions and forms
Evidence of CoverageEvidence of Coverage – Aspire Health Advantage (HMO) PDF | Spanish (en español PDF)
Evidence of Coverage – Aspire Health Plus (HMO-POS) PDF | Spanish (en español PDF)
Evidence of Coverage – Aspire Health Value (HMO) PDF | Spanish (en español PDF)
Evidence of Coverage – Aspire Health Group Plus (HMO-POS) PDF
If you rely on regular or long-term medications, there may be a better way to get your prescriptions filled. MedImpact Direct is home delivery and a smart, simple way for you to get prescriptions delivered to your door. 2020 Mail order pharmacy. And, you save money on your prescription co-pays with our 3 months supply for two co-payments.
Medicare Star Rating
Member formsMedicare's Redetermination request form PDF | Formulario de solicitud de redeterminación de Medicare Spanish (en español PDF)
Multi-language interpreter services
Provider DirectoryProvider and Pharmacy Directory PDF | Directorio de Proveedores y Farmacias Spanish (en español PDF)
If you would like to request a mailed copy of the current Provider and Pharmacy Directory, or if you need help finding a network provider and/or pharmacy, please call member services toll free at (855) 570-1600 (TTY users call 711) or click on the following link for more information:
Summary of Benefits for Monterey County