IMPORTANT MEMBER UPDATE:
The state government office that oversees QUEST Integration has restarted their renewals process. Please be on the lookout for a pink envelope in the mail.
Renewals for Maui County members will begin in April 2024. Visit medquest.hawaii.gov for more information.
Keep us informed of your current address and phone number. Call us at 1-877-973-0712 if you have any questions.

Member Documents

 

2024 MATERIALS

AlohaCare Advantage Plus (HMO D-SNP)

Click here to request hard copies of any of these materials. Hard copies are free upon request and will be provided within three business days. 

 

2024 Annual Notice of Changes

Annual Notice of Changes tells you about the changes to the plan's costs and benefits for the upcoming year.

2024 Evidence of Coverage

Evidence of Coverage gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2024. It explains how to get coverage for the health care services and prescription drugs you need.

2024 Summary of Benefits

Summary of Benefits tells you some features of our plan. It doesn't list every service that we cover or list every limitation or exclusion. To get a complete list of our benefits, please call AlohaCare Advantage Plus (HMO D-SNP) and ask for the "Evidence of Coverage".

2024 Provider and Pharmacy Directory

 

This directory provides a list of AlohaCare Advantage and AlohaCare Advantage Plus’ (HMO D-SNP) network providers.

2024 Comprehensive Formulary

Formulary Updates:

A formulary is a list of covered drugs selected by AlohaCare Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.

 


AlohaCare Advantage (HMO D-SNP)

2024 Evidence of Coverage

Evidence of Coverage gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2024. It explains how to get coverage for the health care services and prescription drugs you need.

2024 Summary of Benefits

Summary of Benefits tells you some features of our plan. It doesn't list every service that we cover or list every limitation or exclusion. To get a complete list of our benefits, please call AlohaCare Advantage Plus (HMO D-SNP) and ask for the "Evidence of Coverage".

2024 Provider and Pharmacy Directory

 

This directory provides a list of AlohaCare Advantage and AlohaCare Advantage Plus’ (HMO D-SNP) network providers.

2024 Comprehensive Formulary 

Formulary Updates:

A formulary is a list of covered drugs selected by AlohaCare Advantage in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.

Other AlohaCare Medicare Plan Materials

 

2024 Star Rating

The Medicare Program rates all health and prescription drug plans each year, based on a plan's quality and performance. Medicare Plan Ratings help you know how good a job our plan is doing.

2024 Prior Authorization Criteria

This document discusses the need for prior authorization for certain drugs that are on the formulary or drugs that are not on the formulary.

2024 Step Therapy Drugs

AlohaCare requires you to first try one drug to treat your medical condition before we will cover another drug for that condition.

COORDINATION OF BENEFITS/DIRECT CLAIM

Submit this form with your receipts to help pay for out-of-pocket drug costs.

CarelonRx Home Delivery Mail Service Order Form

Complete and mail in this form to sign up to have medicine you take on a regular basis to be delivered to your home.
Multi-Language InsertWe have free interpreter services to answer any questions you may have about our health or drug plan.
Non-Emergent Medical Transportation: IntelliRideStarting March 1, 2021, IntelliRide will make your travel arrangements.

Privacy Notice

This notice describes how medical information about you may be used and shared and obtained.

World-Wide Benefit Reimbursement Form

AlohaCare Advantage and AlohaCare Advantage Plus have a limited annual benefit that covers emergency services you may need while traveling outside of the U.S.
 

AlohaCare Medicare Plans Model of Care Program

AlohaCare's Medicare Plans are dual-eligible Special Needs Plans (D-SNP). One advantage for members of SNP plans is the SNP Model of Care, which is an interdisciplinary care coordination program.

The following are links to resources related to the SNP Model of Care.

Injury/Illness Form

Please complete this form if your injury or illness happened at work or as a result of an automobile accident.

Health Risk Assessment

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