McLaren Medicare
Plan Documents and Forms

Plan Documents and Forms

Appoint a Representative

• Appointment a Representative

Auto Withdrawal Payment

• Electronic Funds Transfer (EFT) Payments

Dental Certificates of Coverage

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

Evidence of Coverage

• McLaren Medicare Inspire
• McLaren Medicare Inspire Plus
• McLaren Medicare Inspire Flex
• McLaren Medicare Inspire Duals

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