Health Risk Survey
To meet Medicare requirements, Troy Medicare asks that every member complete a Health Risk Survey. Please answer the survey as completely as possible. Your responses will not affect your enrollment, benefits, or copays.
What happens next?
Once we receive your completed survey, a dedicated Troy Medicare Care Manager will call you. During the call, the Care Manager will:
- Review the health information you provided.
- Answer any questions you have.
- Discuss ways to support you in managing your health conditions or medications.
- Help address any difficulties or assistance you may need.
Summary of Benefits
This booklet gives you a summary of what we cover and what you pay. It doesn’t list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, call us and ask for the Evidence of Coverage.
Evidence of Coverage
This booklet gives you the details about your Medicare health care and prescription drug coverage. It explains how to get coverage for the health care services and prescription drugs you need. This is an important document, so keep a link to it handy.
LIS Premium Summary Chart
Medicare Star Ratings
Annual Notice of Change
Plan Forms
Prescription Drug Plan Forms
Prescription Drug Coverage Determination Form - Member/Provider
Use this form when you want to ask for a coverage determination about a prescription drug.
Prescription Drug Coverage Redetermination Form - Member/Provider
Use this form when you want to appeal a coverage determination about a prescription drug.
Electronic Plan Forms
Electronic Prescription Drug Coverage Determination Form - Member
Use this online form when you want to ask for a coverage determination about a prescription drug.
Electronic Prescription Drug Coverage Redetermination Request - Member
Use this online form when you want to appeal a coverage determination about a prescription drug.
Electronic Prescription Drug Coverage Determination Request - Provider
Use this online form when you are a provider and you want to ask for a coverage determination about a prescription drug.