Find a Document or Form

Find a Sonder Form

Documents & Forms Download Link
Pharmacy – 2024 Step Therapy (ST) Criteria – Complete Health Medicare Advantage (HMO), Tiers Medicare Advantage (HMO), and Dual Complete (HMO D-SNP)
Pharmacy – 2024 Step Therapy (ST) Criteria – Diabetes Wellness (HMO C-SNP) and Heart Healthy (HMO C-SNP)
Pharmacy – 2024 Prior Authorization (PA) Criteria – Complete Health Medicare Advantage (HMO), Tiers Medicare Advantage (HMO), and Dual Complete (HMO D-SNP) 2024 Prior Authorization (PA) Criteria
Pharmacy – 2024 Prior Authorization (PA) Criteria – Diabetes Wellness (HMO C-SNP) and Heart Healthy (HMO C-SNP)
Pharmacy – 2024 Formulary List of Covered Drugs – Diabetes Wellness and Heart Healthy (HMO C-SNP) 2024 Formulary List of Covered Drugs
Pharmacy – 2024 Formulary List of Covered Drugs – Dual Complete (HMO D-SNP)
Pharmacy – 2024 Formulary List of Covered Drugs – Complete Health Medicare Advantage (HMO) and Tiers Medicare Advantage (HMO)
2024 Summary of Benefits – Sonder Complete Health Medicare Advantage (HMO)
2024 Summary of Benefits – Sonder Diabetes Wellness (HMO C-SNP)
2024 Summary of Benefits – Sonder Heart Healthy (HMO C-SNP)
2024 Summary of Benefits – Sonder Dual Complete (HMO D-SNP)
2024 Summary of Benefits – Sonder Tiers Medicare Advantage (HMO)
2024 Grocery Catalog (English)
2024 Over-The-Counter Catalog (Spanish)
2024 Over-The-Counter Catalog (Chinese)
2024 Over-The-Counter Catalog (Korean)
2024 Grocery Catalog
2024 Grocery Catalog (Spanish)
2024 Grocery Catalog (Korean)
Appointment of Representative CMS – 1696
Appointment of Representative CMS – 1696 (Large Print)
Nombramiento de la Representante CMS – 1696
Nombramiento del representante CMS – 1696 (letra grande)
Authorization to Use or Disclose PHI Form
CSNP Prequalification Form & Verification Form
Grievance Submission Form
Low Income Subsidy (LIS) Information
Member Appeal Request
Revocation of Authorization to Use or Disclose PHI Form
Sonder Health Plans Advance Directive
2023 Summary of Benefits – Sonder Complete Health Medicare Advantage (HMO)
2023 Summary of Benefits – Sonder Diabetes Wellness (HMO C-SNP)
2023 Summary of Benefits – Sonder Heart Healthy (HMO C-SNP)
2023 Summary of Benefits – Sonder Dual Complete (HMO D-SNP)
Pharmacy – 2023 Complete Health Medicare Advantage (HMO – H1748 – 001) Comprehensive Formulary
Pharmacy – 2023 Diabetes Wellness / Heart Healthy (HMO C-SNP) Comprehensive Formulary
Pharmacy – 2023 Dual Complete (HMO D-SNP) Comprehensive Formulary
Pharmacy – 2023 Prior Authorization (PA) Criteria for Complete Health Medicare Advantage (HMO – 001) & Dual Complete (HMO D-SNP – 005)
Pharmacy – 2023 Prior Authorization (PA) Criteria for Sonder Diabetes Wellness / Heart Healthy (HMO C-SNP)
Pharmacy – 2023 Step Therapy (ST) Criteria for Complete Health Medicare Advantage (HMO – 001) & Dual Complete (HMO D-SNP – 005)
Pharmacy – 2023 Step Therapy (ST) Criteria for Sonder Diabetes Wellness / Heart Healthy (HMO C-SNP)
Pharmacy – 2023 Formulary Addendum for Complete Health Medicare Advantage (HMO – 001) & Dual Complete (HMO D-SNP – 005)
Pharmacy – 2023 Formulary Addendum for Sonder Diabetes Wellness / Heart Healthy (HMO C-SNP)
Pharmacy – Part D Drug Coverage Determination / Exception / Prior Authorization Form
Pharmacy – Part D Drug Appeal / Redetermination Form
Pharmacy – Part D Drug Direct Member Reimbursement (DMR) Form
Pharmacy – Medicare Prescription Drug Coverage and Your Rights – Notice CMS-10147
Pharmacy – Medicare Prescription Drug Coverage and Your Rights – Notice CMS-10147 Spanish