McLaren Medicare
Plan Documents and Forms 2023

Plan Documents and Forms 2023

Appoint a Representative

• Appoint a Representative

Annual Notice of Change (ANOC)

• McLaren Medicare Inspire (HMO)
• McLaren Medicare Inspire Plus (HMO)
• McLaren Medicare Inspire Flex Region 1 (HMO-POS)
• McLaren Medicare Inspire Flex Region 2 (HMO-POS)
• McLaren Medicare Inspire Duals (HMO DSNP)

Auto Withdrawal Payment

• Electronic Funds Transfer (EFT) Payments 

Dental Certificates of Coverage

• Delta Dental - for Inspire, Inspire Plus and Inspire Flex
• Delta Dental - for optional supplemental benefit Option 1
• Delta Dental - for optional supplemental benefit Option 2
• Dental Dental - for Inspire Duals

Evidence of Coverage

• McLaren Medicare Inspire (HMO)
• Mclaren Medicare Inspire Plus (HMO)
• McLaren Medicare Inspire Flex Region 1 (HMO-POS)
• McLaren Medicare Inspire Flex Region 2 (HMO-POS)
• McLaren Medicare Inspire Duals (HMO DSNP)

Prior Authorization Form

• Prior Authorization Form for Members

Member Reimbursement Form

• Member Reimbursement Form
  

Summary of Benefits

• Summary of Benefits
• Summary of Benefits D-SNP