- Senior Whole Health – MA - https://www.seniorwholehealthma.com -

2021 Member Materials and Forms

On this page, you can find important documents related to your Senior Whole Health of Massachusetts health plan. Click the links below to download each document.

Annual Materials 2021

Summary of Benefits: A summary of what we cover and what you get from Senior Whole Health. For a complete list of covered services and exclusions, refer to your Evidence of Coverage.

Summary of Benefits Addendum: For SCO (MassHealth Medicaid only) members, this document provides additional information.

Evidence of Coverage (EOC): Your member handbook, or EOC, gives you detailed information about your benefits and services, and all the information you need on working with Senior Whole Health.

(SCO) EOC Addendum: For SCO (MassHealth Medicaid only) members, this document provides additional information.

Part D Formulary (October 2021)
This lists all of the drugs that we cover. The drugs on the formulary are selected by our plan with the help of a team of health care providers.

SCO Formulary (October 2021)
This lists all of the drugs that we cover in our SCO plan. The drugs on the formulary are selected by our plan with the help of a team of health care providers.

Annual Notice of Changes: Describes changes to your SWH plan coverage, costs or service area.

LIS Rider: Describes the extra help you get paying for your prescription drugs.

LIS Premium Summary:  This chart will show you what your monthly premium will be if you get extra help from Medicare to help pay for your Medicare prescription drug plan costs.

Pharmacy & Prescription Drug Materials 

Part D Formulary (October 2021)

SCO Formulary (October 2021)
Part D Formulary Change Chart (October 2021)
Prior Authorization Criteria (October 2021)
Medical pharmacy drugs (J-Code) requiring Prior Authorization List (updated May 1, 2021)
Medication Therapy Management Program Overview 

Frequently Used  Forms

Online Request for Medicare Part D RedeterminationOnline Request for Medicare Part D Prescription Drug Coverage Prescription Coverage Determination Form (PDF) 
Medicare Reconsideration Request Form
Medicare Redetermination Request Form
Direct Reimbursement Claim Form
Appointment of Representative Form
Health Care Proxy Form
Request for Reconsideration of Medicare Prescription Drug Denial

Provider and Pharmacy Directories 

A list of network providers and pharmacies you may use to get care, services and prescription drugs.

Bristol and Plymouth counties (October 2021)
Hampden and Worcester counties (October 2021)
Middlesex and Essex counties (October 2021)
Norfolk and Suffolk counties (October 2021) 

2021 Behavioral Health Providers 
2021 Dental Health Providers

Other Member Materials

2021 Medicare Star Ratings: The Centers for Medicare & Medicaid Services (CMS) uses a five-star quality rating system to measure the experiences Medicare beneficiaries have with their health plan.
Behavioral Health Services 
Over-The-Counter (OTC) and Additional Coverage Drug List 
Non-Discrimination Notice

 

Health and Education Materials

Telehealth — sometimes called telemedicine — is the use of electronic information and telecommunication technologies to provide care when you and the doctor are not in the same place at the same time. If you have a phone or a device with internet access, you already have everything you need to get medical care or services through telehealth — you may be able to:

  • Talk to your doctor live over the phone or video chat.
  • Send and receive messages from your doctor using chat messaging, email, secure messaging, and secure file exchange.
  • Use remote patient monitoring so your doctor can check on you at home.

Find out how to stay healthy and at home with Telehealth Resources here. (English version)

Mandarin (Chinese version)

Portuguese version

Spanish version

Vietnamese version

According to the CDC, Flu Symptoms Influenza (flu) can cause mild to severe illness, and at times can lead to death. Flu is different from a cold. Flu usually comes on suddenly.

Understand flu symptoms and how to prevent the flu here. (English version)

Mandarin (Chinese version)

Portuguese version

Spanish version

Vietnamese version

Take charge of your health with these important SWH Healthwise materials

 

 

 

Recent Drug Recalls - last updated 10/15/2021

10/14/2021
Irbesartan and Hydrochlorothiazide Tablets USP
150mg/12.5 mg and 300mg/12.5 mg
Lupin Pharmaceuticals, Inc.
FDA website

 

10/12/2021
Lidocaine Hydrochloride Topical Solution
USP 4% (40 mg/mL)
Teligent Pharma, Inc.
FDA website

 

10/01/2021
Lotrimin AF and Tinactin Over the Counter (OTC)
Antifungal spray products
Bayer U.S. LLC
FDA Website

 

9/30/2021
Coppertone aerosol sunscreen spray products
Johnson & Johnson
FDA website

9/26/2021
Glucagon Emergency Kit
Eli Lilly and Company
FDA website

 

9/21/2021
IntegraDose Cefazolin
IntegraDose Compounding Services, LLC
FDA website

 

9/16/2021
CHANTIX
Pfizer
FDA website

 

9/13/2021
Ruzurgi® (amifampridine) 10 mg tablets
Jacobus Pharmaceutical Company Inc.
FDA website