McLaren Medicare
Plan Documents and Forms 2026

Plan Documents and Forms 2026

Listed below are key documents and forms, including coverage details and reimbursement forms. If you need help finding a document or have questions, contact Member Services:

Phone: 833-358-2404 (TTY: 711)
April 1-Sept. 30: Monday-Friday, 8 a.m. to 8 p.m.
Oct. 1-March 31: Seven days a week, 8 a.m. to 8 p.m.
(except Thanksgiving and Christmas days)

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)

Auto Withdrawal Payment

• Electronic Funds Transfer (EFT) Payments 

Dental Certificates of Coverage

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

Evidence of Coverage

• McLaren Medicare Inspire (HMO)
• Mclaren Medicare Inspire Plus (HMO)
• McLaren Medicare Inspire Select (HMO)

PHI Authorization Form

• PHI Authorization Form

Prior Authorization Form

• Prior Authorization Form for Members

Member Reimbursement Form

• Member Reimbursement Form
  

Service Area Map

• Service Area Map

Summary of Benefits

• Summary of Benefits