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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
Mid-Year Change Notification
Revocation of Authorization to Use or Disclose PHI Form
Sonder Health Plans Advance Directive
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

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