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Forms and resources | Mass General Brigham Health Plan
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Resources</span> </span> <span class="__separator"></span> <meta itemprop="position" content="2"/> </li> <li class="__item" aria-current="page" aria-posinset="3" aria-setsize="3" role="listitem" itemprop="itemListElement" itemscope itemtype="http://schema.org/ListItem"> <span itemprop="name">Forms and Resources</span> <span class="__separator"></span> <meta itemprop="position" content="3"/> </li> </ol> </nav> </div> <div class="maincontent"><div id="main-content"></div> </div> </div> </div> </div> <div class="container responsivegrid aem-GridColumn aem-GridColumn--default--12"> <div id="container-3dcf65601e" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="containerlayout aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --grid-normal-one-column --full-width --bg-color-dark-blue"> <div class="cmp-containerlayout__content-column "> <div class="contentlayout --margin-small-bottom --paragraph-width"><div class="cmp-contentlayout"> <div class="cmp-contentlayout__content --content-col-content --"> <div class="text component-heading-typography neutral-white-color"> <div id="text-354c1d447d" class="cmp-text"> <h2> </h2> <h2 style=" margin-left: 40.0px; ">Forms, resources, and coverage criteria for your plan</h2> </div> </div> <div class="text component-body-typography neutral-white-color"> <div id="text-92580f34f1" class="cmp-text"> <p style=" margin-left: 40.0px; ">Find all the information you need to enroll in a plan and manage your care.</p> </div> </div> </div> </div> </div> </div> </div> </div> <div class="containerlayout --margin-large-top --margin-large-bottom aem-GridColumn aem-GridColumn--default--12"><div class="cmp-containerlayout --site-max-width --grid-normal-one-column --bg-color-neutral-white"> <div class="cmp-containerlayout__content-column "> <div class="accordion panelcontainer"> <div id="accordion-84a2724e00" class="cmp-accordion" data-cmp-is="accordion" data-placeholder-text="false"> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-84a2724e00-item-62e6c5e000":{"@type":"mgbhp/components/accordion/item","dc:title":"Medical necessity criteria and guidelines"}}" id="accordion-84a2724e00-item-62e6c5e000"> <h3 class="cmp-accordion__header"> <button id="accordion-84a2724e00-item-62e6c5e000-button" class="cmp-accordion__button" type="button" aria-controls="accordion-84a2724e00-item-62e6c5e000-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Medical necessity criteria and guidelines</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-84a2724e00-item-62e6c5e000-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-84a2724e00-item-62e6c5e000-button"><div class="container responsivegrid"> <div id="container-62e6c5e000" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="text component-body-typography aem-GridColumn aem-GridColumn--default--12"> <div id="text-265df3ad79" class="cmp-text"> <p>These resources explain how we define services that are medically necessary.</p> <p><b>Explore all Mass General Brigham Advantage medical necessity criteria and guidelines:</b></p> <p><a href="https://massgeneralbrighamhealthplan.org/providers/medical-policies?pk_vid=dd45271f6904d97c17271178279e0b70" target="_blank" rel="noopener noreferrer"><b>Mass General Brigham Health Plan medical policies</b></a></p> <p><a href="https://public.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/guidelines-policies.html" target="_blank" rel="noopener noreferrer"><b>Optum behavioral health criteria</b></a></p> <p><a href="https://www.evicore.com/provider/clinical-guidelines-details?solution=laboratory%20management&hPlan=Mass%20General%20Brigham%20Health%20Plan" target="_blank" rel="noopener noreferrer"><b>EviCore genetic testing criteria</b></a></p> <p><a href="https://prod.ds.interqual.com/service/connect/transparency?tid=6cbb15cb-006c-4708-b49c-c270b9a69e8d" target="_blank" rel="noopener noreferrer"><b>Medical Necessity Criteria </b></a><br /> View medical necessity criteria and guidelines from Mass General Brigham Health Plan.</p> <p>First time users will be asked to create a One Healthcare ID account. Please enter your name and email address and accept the InterQual End User License Agreement to continue. You will then be redirected to our partner website for medical necessity criteria information.</p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-84a2724e00-item-ded7f49312":{"@type":"mgbhp/components/accordion/item","dc:title":"Drug coverage and pharmacy"}}" id="accordion-84a2724e00-item-ded7f49312"> <h3 class="cmp-accordion__header"> <button id="accordion-84a2724e00-item-ded7f49312-button" class="cmp-accordion__button" type="button" aria-controls="accordion-84a2724e00-item-ded7f49312-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Drug coverage and pharmacy</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-84a2724e00-item-ded7f49312-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-84a2724e00-item-ded7f49312-button"><div class="container responsivegrid"> <div id="container-ded7f49312" class="cmp-container"> <div class="aem-Grid aem-Grid--12 aem-Grid--default--12 "> <div class="text component-body-typography aem-GridColumn aem-GridColumn--default--12"> <div id="text-6def3c3a68" class="cmp-text"> <p>These resources explain how to verify prescription drug coverage and how to submit requests and authorizations for medication.</p> <p><b>Explore all Mass General Brigham Advantage drug coverage forms and resources:</b></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Mail%20Service%20Order.pdf" target="_blank" rel="noopener noreferrer">CVS Caremark Mail Service Order Form (PDF)</a><br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_MedicarePartD_PrescriptionClaimForm.pdf" target="_blank" rel="noopener noreferrer">CVS Caremark Medicare Part D Prescription Claim Form (PDF)</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_MedAdvantage-Notice-of-Change.pdf" target="_blank" rel="noopener noreferrer">Medicare Advantage Formulary Notice of Changes – November 2024</a></p> <p><b>Prior Authorization Information </b><br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_Part_B_Medical_Service_Drugs_Requiring_PA.pdf" target="_blank" rel="noopener noreferrer">Part B Medical Service Drugs Requiring Prior Authorization (PDF)</a><br /> These drug requests are submitted to Mass General Brigham Health Plan. </p> <p>Part B Medical Drugs Requiring Prior Authorization: <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2025_Part_B_Medical_Drugs_Requiring_PA.pdf" target="_blank" rel="noopener noreferrer">2025</a><i> </i>| <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2024_Part_B_Medical_Drugs_Requiring_PA.pdf" target="_blank" rel="noopener noreferrer">2024</a> <br /> <br /> Prior authorization is required for the drugs listed within this document when being administered using the member’s medical Part B benefit. Requests for the drugs in this document should be submitted to Novologix.</p> <p>Part B Medical Drugs Requiring Prior Authorization Guidelines: <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2024_Part_B_Medical_Drugs_Requiring_PA_Guidelines.pdf" target="_blank" rel="noopener noreferrer">2024</a></p> <p><b>Coverage Determination Requests </b><br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Coverage%20Determination%20Request.pdf" target="_blank" rel="noopener noreferrer">Medicare Prescription Drug Coverage Determination Request Form (PDF)</a><br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Prescription_Drug_OD_Request.pdf" target="_blank" rel="noopener noreferrer">Part B Prescription Medical Drug Organization Determination Request Form (PDF)</a></p> </div> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-84a2724e00-item-f62463f032":{"@type":"mgbhp/components/accordion/item","dc:title":"Enrollment forms"}}" id="accordion-84a2724e00-item-f62463f032"> <h3 class="cmp-accordion__header"> <button id="accordion-84a2724e00-item-f62463f032-button" class="cmp-accordion__button" type="button" aria-controls="accordion-84a2724e00-item-f62463f032-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Enrollment forms</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-84a2724e00-item-f62463f032-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-84a2724e00-item-f62463f032-button"><div class="container responsivegrid"> <div id="container-f62463f032" class="cmp-container"> <div class="text component-body-typography"> <div id="text-00760c4dd2" class="cmp-text"> <p>Use these forms to enroll in a plan with us or review your rights and responsibilities if you want to change plans.</p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_2025_MedicareAdv_Enrollment.pdf" target="_blank" rel="noopener noreferrer">Individual Enrollment Application 2025 — Mass General Brigham Health Plan (PDF)</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_2024_MedicareAdv_Enrollment.pdf" target="_blank" rel="noopener noreferrer">Individual Enrollment Application 2024 — Mass General Brigham Health Plan (PDF)</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_Rights_Responsibilities_Upon_Disenrollment.pdf" target="_blank" rel="noopener noreferrer">Disenrollment Rights & Responsibilities (PDF)</a></p> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-84a2724e00-item-312aee3e65":{"@type":"mgbhp/components/accordion/item","dc:title":"Reimbursement and order forms"}}" id="accordion-84a2724e00-item-312aee3e65"> <h3 class="cmp-accordion__header"> <button id="accordion-84a2724e00-item-312aee3e65-button" class="cmp-accordion__button" type="button" aria-controls="accordion-84a2724e00-item-312aee3e65-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Reimbursement and order forms</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-84a2724e00-item-312aee3e65-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-84a2724e00-item-312aee3e65-button"><div class="container responsivegrid"> <div id="container-312aee3e65" class="cmp-container"> <div class="text component-body-typography"> <div id="text-c04cdd7590" class="cmp-text"> <p><b>Reimbursement forms</b></p> <p>Use these forms to request reimbursements for qualifying healthcare expenses. </p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Med_Adv_Medical_Reimbursement.pdf" target="_blank" rel="noopener noreferrer">Medical Reimbursement Request Form (PDF)</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Med_Adv_Behavioral%20Health%20Reimbursement.pdf" target="_blank" rel="noopener noreferrer">Behavioral Health Reimbursement Request Form (PDF)</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Fitness%20Reimbursement%20Form%20MA.pdf" target="_blank" rel="noopener noreferrer">2024 Fitness Benefit Coverage Request Form (PDF)</a><br /> <br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Weight%20Loss%20Reimbursement%20Form%20MA.pdf" target="_blank" rel="noopener noreferrer">2024 Weight Loss Program Benefit Coverage Request Form (PDF) </a><br /> </p> <p><b><br /> EyeMed reimbursement form:</b></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_EyeMed_OutOfNetworkReimbursement.pdf" target="_blank" rel="noopener noreferrer">EyeMed Out of Network Reimbursement Form (PDF)</a></p> <p> </p> <p><b>Order forms</b></p> <p>Use these forms to order products and prescriptions via mail.</p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Mail%20Service%20Order.pdf" target="_blank" rel="noopener noreferrer">CVS Caremark Mail Service Order Form (PDF)</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_OTC%20Order.pdf" target="_blank" rel="noopener noreferrer">Over-the-counter (OTC) product order form (PDF)</a></p> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-84a2724e00-item-2451a028ed":{"@type":"mgbhp/components/accordion/item","dc:title":"Information release and authorization forms"}}" id="accordion-84a2724e00-item-2451a028ed"> <h3 class="cmp-accordion__header"> <button id="accordion-84a2724e00-item-2451a028ed-button" class="cmp-accordion__button" type="button" aria-controls="accordion-84a2724e00-item-2451a028ed-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Information release and authorization forms</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-84a2724e00-item-2451a028ed-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-84a2724e00-item-2451a028ed-button"><div class="container responsivegrid"> <div id="container-2451a028ed" class="cmp-container"> <div class="text component-body-typography"> <div id="text-07728238d3" class="cmp-text"> <p>Use this form to give a friend, relative, doctor, or other person the right to legally represent you for healthcare coverage decisions. </p> <p>If you would like a friend, relative, doctor, or other person to act for you as your “representative” to ask for a coverage decision (such as whether a service is covered) or make an appeal, you may need to appoint them as your representative. If that person is already legally authorized to act as your representative under State law, you do not need to appoint them to represent you. If you want to appoint someone to be your representative, complete the <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_AppointmentofRepresentative.pdf" target="_blank" rel="noopener noreferrer">“Appointment of Representative” form</a>. The form gives that person permission to act on your behalf. It must be signed by you and by the person who you would like to act on your behalf. You must give Mass General Brigham Health Plan a copy of the signed form. You also have the right to hire a lawyer to act for you. You may contact your own lawyer, or get the name of a lawyer from your local bar association or other referral service. There are also groups that will give you free legal services if you qualify. However, you are not required to hire a lawyer to ask for any kind of coverage decision or to appeal a decision.</p> <p><b>Authorizations</b></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/FRM_Request%20for%20Medicare%20Service%20Coverage%20Determination.pdf" target="_blank" rel="noopener noreferrer">Request For Medicare Service Coverage Determination (PDF)</a><br /> This form can be used to submit information to Mass General Brigham Health Plan to help determine if a service or Part B Medical service drug is covered.</p> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-84a2724e00-item-0b6c12f6f6":{"@type":"mgbhp/components/accordion/item","dc:title":"Appeals and financial assistance"}}" id="accordion-84a2724e00-item-0b6c12f6f6"> <h3 class="cmp-accordion__header"> <button id="accordion-84a2724e00-item-0b6c12f6f6-button" class="cmp-accordion__button" type="button" aria-controls="accordion-84a2724e00-item-0b6c12f6f6-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Appeals and financial assistance</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-84a2724e00-item-0b6c12f6f6-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-84a2724e00-item-0b6c12f6f6-button"><div class="container responsivegrid"> <div id="container-0b6c12f6f6" class="cmp-container"> <div class="text component-body-typography"> <div id="text-7964a1cc7b" class="cmp-text"> <p>Use these documents for help with financial assistance, disaster relief, or to file a grievance or make an appeal.</p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/LTR_Grievances_Appeals.pdf" target="_blank" rel="noopener noreferrer">Grievances and Appeals (PDF)</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/CY%202024%20LIS%20Premium%20Summary%20model.pdf" target="_blank" rel="noopener noreferrer">Extra Help Subsidy (PDF)</a></p> <p><a href="/plans/medicare-savings">Medicare Savings Program</a></p> <p><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_Receiving_Care_During_A_Disaster.pdf" target="_blank" rel="noopener noreferrer">Getting Care During a Disaster (PDF)</a><br /> <br /> <br /> Appeals and Grievances Data Report January 1, 2023 to December 31, 2023:</p> <ul><li><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2023_HMO-POS_Appeals_and_Grievances_Data.pdf" target="_blank" rel="noopener noreferrer">Mass General Brigham HMO-POS Health Plan</a></li><li><a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_2023_PPO_Appeals_and_Grievances_Data.pdf" target="_blank" rel="noopener noreferrer">Mass General Brigham PPO Health Plan</a></li></ul> </div> </div> </div> </div> </div> </div> <div class="cmp-accordion__item" data-cmp-hook-accordion="item" data-cmp-data-layer="{"accordion-84a2724e00-item-a44228fa85":{"@type":"mgbhp/components/accordion/item","dc:title":"Medicare star ratings"}}" id="accordion-84a2724e00-item-a44228fa85"> <h3 class="cmp-accordion__header"> <button id="accordion-84a2724e00-item-a44228fa85-button" class="cmp-accordion__button" type="button" aria-controls="accordion-84a2724e00-item-a44228fa85-panel" data-cmp-hook-accordion="button"> <span class="cmp-accordion__title">Medicare star ratings</span> <span class="cmp-accordion__icon"></span> </button> </h3> <div data-cmp-hook-accordion="panel" id="accordion-84a2724e00-item-a44228fa85-panel" class="cmp-accordion__panel cmp-accordion__panel--hidden" role="region" aria-labelledby="accordion-84a2724e00-item-a44228fa85-button"><div class="container responsivegrid"> <div id="container-a44228fa85" class="cmp-container"> <div class="text component-body-typography"> <div id="text-42aebfe6eb" class="cmp-text"> <p>Use these resources to verify Mass General Brigham Health Plan Medicare star ratings.</p> <p><b>2025 ratings </b><br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/2025%20Star%20Rating%20H6487.pdf" target="_blank" rel="noopener noreferrer">Mass General Brigham Health Plan - H6847</a><br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/2025%20Star%20Rating%20H9485.pdf" target="_blank" rel="noopener noreferrer">Mass General Brigham Health Plan - H9485</a></p> <p><b>2024 ratings </b><br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/2024%20Star%20Rating%20H6487.pdf" target="_blank" rel="noopener noreferrer">Mass General Brigham Health Plan - H6847</a> <br /> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/2024%20Star%20Rating%20H9485.pdf" target="_blank" rel="noopener noreferrer">Mass General Brigham Health Plan - H9485</a></p> </div> </div> </div> </div> </div> </div> </div> </div> <div class="spacer"><div class="cmp-custom-spacer --medium "> </div> </div> <div class="contactus"><div class="cmp-custom-contact-us__container "> <din class="cmp-custom-contact-us__top"> <div class="cmp-custom-contact-us__top-img"> <svg width="404" height="300" viewBox="0 0 404 300" fill="none" xmlns="http://www.w3.org/2000/svg"> <path d="M103.794 131.899C103.794 131.899 104.96 131.871 105.384 131.862C119.489 131.569 128.857 118.345 128.857 103.845V103.43C128.857 87.808 116.234 75.1429 100.663 75.1429H30.1949C14.623 75.1429 2.00043 87.808 2.00043 103.43V103.845C2.00043 119.467 14.623 132.132 30.1949 132.132H82.1628L104.094 150.571" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M300.206 58.756C300.206 58.756 299.04 58.728 298.617 58.7195C284.512 58.4257 275.143 45.2019 275.143 30.7019V30.2876C275.143 14.6651 287.766 2 303.337 2H373.806C389.377 2 402 14.6651 402 30.2876V30.7019C402 46.3244 389.377 58.9887 373.806 58.9887H321.838L299.907 77.4285" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M319.464 175.577C319.464 175.577 318.519 175.555 318.175 175.548C306.739 175.312 299.143 164.692 299.143 153.049V152.715C299.143 140.17 309.377 130 322.003 130H379.139C391.766 130 402 140.17 402 152.715V153.049C402 165.594 391.766 175.764 379.139 175.764H337.003L319.222 190.571" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M352.286 175.714V284.285" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M351.714 130V99.2899C351.714 96.6842 349.607 94.5714 347.007 94.5714H266.5" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M351.926 296.857H26.108C20.3682 296.857 15.7146 292.098 15.7146 286.227V284.285H396.856" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M57.4286 132.286V284.286" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M263.09 193.258C267.283 191.69 272.11 188.314 274.914 183.409L268.317 176.34C267.167 174.852 266.542 173.022 266.542 171.138V104.515C266.542 67.6004 235.909 37.8784 198.804 39.6342C164.049 41.2791 137.311 71.3624 137.311 106.338V166.72C137.311 173.186 136.504 175.233 135.053 176.803L129.435 182.876C129.435 182.876 133.787 190.417 140.894 193.841" stroke="#003A96" stroke-width="3"/> <path d="M264 193.072C258.329 195.187 251.504 195.414 248.795 195.045C240.317 193.89 225.956 185.318 223.992 165.757M140.5 193.574C142.755 194.656 145.263 195.789 148.021 195.676C159.108 195.219 177.82 190.499 178.941 165.757" stroke="#003A96" stroke-width="3"/> <path d="M166.264 190.145C166.264 190.145 177.313 210.78 201.872 210.466C226.431 210.152 238.083 190.145 238.083 190.145" stroke="#003A96" stroke-width="3"/> <path d="M184.586 82.0566C184.586 82.0566 177.817 112.112 156.531 110.531C156.531 110.531 147.14 104.519 149.018 118.756C150.896 132.993 153.713 130.779 155.904 129.83C155.904 129.83 159.27 141.931 171.478 157.513C178.627 166.637 188.347 174.568 201.871 174.438C211.686 174.345 219.867 169.363 226.337 163.794C241.775 150.506 248.093 129.197 248.093 129.197C248.093 129.197 252.084 132.255 253.18 125.005C254.63 115.411 253.259 105.469 248.876 109.898C248.876 109.898 216.32 121.92 191.904 93.7626" stroke="#003A96" stroke-width="3" stroke-linejoin="round"/> <path d="M277.676 206.774C277.676 206.774 298.58 220.602 301.699 223.974C304.819 227.347 307.939 230.954 308.563 236.969C309.187 242.984 315.427 284.376 315.427 284.376" stroke="#003A96" stroke-width="3"/> <path d="M147.849 195.688C147.849 195.688 98.3401 218.49 95.9901 229.339C93.6401 240.189 88 284.376 88 284.376" stroke="#003A96" stroke-width="3"/> </svg> </div> <din class="cmp-custom-contact-us__top-text"> <div class="cmp-custom-contact-us__top-title"> <p tabindex="0">Have questions?</p> <p tabindex="0">Ask a Medicare Advisor</p> </div> <div class="cmp-custom-contact-us__top-subtitle"> <span class="cmp-custom-contact-us__top-subtitle-text" tabindex="0"> Our dedicated Medicare Advisors are here to help. 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Mass General Brigham Health Plan is an HMO-POS/PPO organization with a Medicare contract. Enrollment in Mass General Brigham Health Plan depends on contract renewal. Other providers/pharmacies are included in our network.</p> <p> </p> <p>Y0166_0860MKT_M2025A</p> <p>Last updated: 10/1/2024 - Pending CMS approval</p> </p> </div> <div class="cmp-custom-footer__main-bottom" alert-message="This link takes you away from the Mass General Brigham Health Plan Medicare Advantage website."> <a href="https://secure.ethicspoint.com/domain/media/en/gui/47250" class="cmp-custom-footer__bottom-bar-item" title="Go to Report a compliance issue page" data-message="Report a compliance issue" target="_blank" tabindex="0" x-cq-linkchecker="skip"><span>Report a compliance issue</span></a> <a href="https://www.medicare.gov/my/medicare-complaint" class="cmp-custom-footer__bottom-bar-item" title="Go to Medicare complaint website" data-message="Medicare complaint website" target="_blank" tabindex="0" x-cq-linkchecker="skip"><span>Medicare complaint website</span></a> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_MedAdv_NonDiscrimination.pdf" class="cmp-custom-footer__bottom-bar-item" title="Open Non-discrimination notice file" data-message="Non-discrimination notice" target="_blank" tabindex="0" x-cq-linkchecker="skip"><span>Non-discrimination notice</span></a> <a href="https://massgeneralbrighamhealthplan.org/privacy" class="cmp-custom-footer__bottom-bar-item" title="Go to Disclaimer, privacy, and security page" data-message="Disclaimer, privacy, and security" target="_blank" tabindex="0" x-cq-linkchecker="skip"><span>Disclaimer, privacy, and security</span></a> <a href="https://resources.massgeneralbrighamhealthplan.org/members/privacy-practices.pdf" class="cmp-custom-footer__bottom-bar-item" title="Open Notice of privacy practices file" data-message="Notice of privacy practices" target="_blank" tabindex="0" x-cq-linkchecker="skip"><span>Notice of privacy practices</span></a> <a href="https://massgeneralbrighamhealthplan.org/web-accessibility-statement" class="cmp-custom-footer__bottom-bar-item" title="Go to Web accessibility statement page" data-message="Web accessibility statement" target="_blank" tabindex="0" x-cq-linkchecker="skip"><span>Web accessibility statement</span></a> <a href="https://resources.massgeneralbrighamhealthplan.org/members/medicareadvantage/DOC_MedAd_Babel.pdf" class="cmp-custom-footer__bottom-bar-item" title="Open Multi-language interpreter services file" data-message="Multi-language interpreter services" target="_blank" tabindex="0" x-cq-linkchecker="skip"><span>Multi-language interpreter services</span></a> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <script async src="/etc.clientlibs/core/wcm/components/commons/site/clientlibs/container.lc-0a6aff292f5cc42142779cde92054524-lc.min.js"></script> <script async src="/etc.clientlibs/mgbhp/clientlibs/clientlib-base.lc-8a0b9b4b439c039a135646a7540c47bb-lc.min.js"></script> </body> </html>