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Amerivantage Classic (HMO)

Fort Bend, Harris, Galveston, Jefferson, Montgomery

Dallas, Denton, Tarrant

Bexar, Comal, Medina

El Paso, Hudspeth

Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry

Hays, Travis, Williamson

* To review benefits provided during disasters, go to Chapter 3, Section 3.3 of this document. Please note that the Medicare Diabetes Prevention Program benefits as described in Chapter 4, Section 2.1 will begin on April 1, 2018.

Amerivantage Select (HMO)

Bexar

El Paso

Fort Bend, Harris, Montgomery

Travis

* To review benefits provided during disasters, go to Chapter 3, Section 3.3 of this document. Please note that the Medicare Diabetes Prevention Program benefits as described in Chapter 4, Section 2.1 will begin on April 1, 2018.

Amerivantage Dual Coordination (HMO SNP)

Fort Bend, Galveston, Harris, Jefferson, Montgomery

Dallas, Denton, Tarrant

Bexar, Comal, Medina

El Paso, Hudspeth

Crosby, Floyd, Garza, Hale, Hockley, Lamb, Lubbock, Lynn, Terry

Hays, Travis, Williamson

* To review benefits provided during disasters, go to Chapter 3, Section 3.3 of this document. Please note that the Medicare Diabetes Prevention Program benefits as described in Chapter 4, Section 2.1 will begin on April 1, 2018.

Amerivantage Dual Premier (HMO SNP)

* To review benefits provided during disasters, go to Chapter 3, Section 3.3 of this document. Please note that the Medicare Diabetes Prevention Program benefits as described in Chapter 4, Section 2.1 will begin on April 1, 2018.

Amerivantage ESRD (HMO-POS SNP)

* To review benefits provided during disasters, go to Chapter 3, Section 3.3 of this document. Please note that the Medicare Diabetes Prevention Program benefits as described in Chapter 4, Section 2.1 will begin on April 1, 2018.

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Call Member Services at 1-866-805-4589 (TTY 711) to ask us to mail you a directory. If you are already a member, you can log in and visit About Your Plan to ask for a mailed directory.

Disenrollment Forms

This form is used by members to disenroll from the current plan

Short Enrollment Forms

This form should only be used by current members to change from their current plan to a new plan offered in their area