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

2022 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.

2022 Annual Materials

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

Summary of Benefits: from Senior Whole Health. For a complete list of covered services and exclusions, refer to your Evidence of Coverage.
English          Spanish

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

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.
English          Spanish

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


2022 Provider & Pharmacy Directories

Directory of Medical Health Providers & Pharmacies
English-Spanish 

Directory of Behavioral Health Providers
English          Spanish

 

2022 Pharmacy & Prescription Drug Materials

LIS Premium Summary: This chart explains your monthly plan premium if you get Extra Help paying for your prescription drugs.
English          Spanish

Part D Formulary
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.
English          Spanish 

SCO Formulary 
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.
English          Spanish 

Senior Whole Health Drug Transition Policy

Medicare Part D Coverage Determination Request Form (download and mail or fax form)
English          Spanish

Drugs Requiring Prior Authorization
English-Spanish

Search the formulary drug list here

Search for a pharmacy here

2022 Member Information

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.
English          Spanish 

Notice of Privacy Practices: This document explains the steps Molina takes to protect your Personal Health Information (PHI).
English          Spanish

Notice of Nondiscrimination: This document explains our policies on nondiscrimination.
English          Spanish 

Multi-Language Interpreter Services: This document explains how to get help if you speak languages other than English.