Medicare Advantage plan documents

For your convenience, below are important forms and documents to help you easily manage your health coverage.

Summary of Benefits

2026 Summary of Benefits — updated 10/1/2025

• AmeriHealth Medicare PPO
• Large print: AmeriHealth Medicare PPO

Evidence of Coverage and Outline of Coverage

The Evidence of Coverage (EOC) is a complete description of your Medicare Advantage plan coverage and your rights as a member. It explains your benefits, premiums, and cost-sharing; conditions and limitations of coverage; and plan rules.

After you've joined the plan, you will receive the Evidence of Coverage in the mail. This is a legal document that should be kept in a safe place.

2026 Evidence of Coverage — updated 10/1/2025

AmeriHealth Medicare PPO EOC

2026 AmeriHealth Medigap Outline of Coverage

• AmeriHealth Medigap Outline of Coverage — effective 1/1/2026

Annual Notice of Changes

2026 Annual Notice of Changes (ANOC) — updated 10/1/2025

• AmeriHealth Medicare Core PPO
• AmeriHealth Medicare Enhanced PPO
• AmeriHealth Medicare Ultimate PPO

Covered non-Medicare dental codes

Select your plan below to view a list of covered preventive/comprehensive non-Medicare dental codes.

• AmeriHealth Medicare Core PPO
• AmeriHealth Medicare Enhanced PPO
• AmeriHealth Medicare Ultimate PPO

 

 

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Website last updated: 12/3/2025