Resources / Materials

2017 List of Drugs (Formulary)
Lista de medicamentos cubiertos para 2017 (Formulario)

2017 Annual Notice of Change
Aviso Anual de Cambios de 2017

2017 Member Handbook
Manual del Afiliado para 2017

Appeals Form

Complaint Form

Multi-Language Interpreter Services

Prior Authorization Form You cannot use this form for Medicare non-covered drugs. Non-covered drugs include but are not limited to fertility drugs, drugs given for weight loss, weight gain or hair growth, over-the-counter drugs, or prescription vitamins (except prenatal vitamins and fluoride preparations).

2017 Summary of Benefits
2017 Resumen de Beneficios

Find a Provider/Pharmacy

Hospice Prior Authorization Form


Please note: By clicking on these links you will be leaving the Superior HealthPlan website.

Appointment of Representative

Prescription Drug Mail Order Form

Formo de pedido por correo de drogas de prescripción

CMS Best Available Evidence (BAE) Policy

File a complaint directly with CMS

Information to help prevent, report and stop Fraud, Waste, and Abuse

Office for Civil Rights

The Office of the Medicare Ombudsman (OMO)

Go to for plan ratings and other information

Last Updated: 04/12/2017