- Home
- Health Choice Pathway
- Members
- Member Information
Member Information
Evidence of Coverage (EOC)
- How to get the care you need, including rules you must follow.
- Your rights as a member of our plan, including treatment decisions and using advance directives.
-
What to do if you have a problem getting covered services.
- We are responsible for treating you with dignity, fairness, and respect.
- A list of Out-of-Network coverage rules.
Summary of Benefits
Plan Year Materials
| DOCUMENT | 2026 PLAN YEAR |
|---|---|
Annual Notice of Changes (ANOC)
| |
Evidence of Coverage
| |
Summary of Benefits | |
Pharmacy Directory | |
Provider Directory
| |
Plan Star Ratings |
- We help members from many backgrounds and language groups.We can help with language and communication needs.
-
Get an interpreter.
- Get materials in another language.
- Get large-print materials.
- Find a doctor who speaks your language.
Need help? Contact Member Services.
Non Discrimination Notice and Notice of Availability
Member Language Services flyer
English | Spanish | Navajo | Vietnamese -
- As a member, you have rights and responsibilities.You have the right to:
- Be treated fairly and with respect.
- Keep your medical records and PHI private.
- Get covered services within a reasonable time.
- Learn about your treatment options.
- Take part in decisions about your care.
- Use Advance Directives.
- File a complaint.
- Get information about your plan, providers, costs, and drug coverage.
Learn More About Your Rights
If you have questions about your rights and protections, please call us or get free help and information from:
DES Aging and Adult Administration
State Health Insurance and Assistance Program
1789 W. Jefferson, St., 950A
Phoenix, AZ 85007The Medicare program has written a booklet called Your Medicare Rights and Protections. To get a free copy, call 1-800-MEDICARE (1-800-633-4227). You can visit Medicare.gov to request this booklet or download a copy.
If you believe you have faced unfair treatment or your rights have been ignored, your actions should depend on your situation. If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, please let us know. Or, you can call the Office for Civil Rights in your area at:
Phoenix Office
275 W. Washington St.,
Phoenix, AZ 85007
Toll free: 1-877-491-5742
Toll free TDD: 1-877-624-8090For any other kind of concern or problem related to your Medicare rights and protections described in this section, you can call us. You can also get help from Arizona’s SHIP.
Your Responsibilities as a Member
As a member of our plan, you also have responsibilities.
Your responsibilities include the following:
-
Learn about your benefits and the rules for getting care.
-
Share information with your doctors. Follow your treatment plan. Ask questions if you do not understand something.
-
Respect other patients and staff. Help keep clinics and offices running smoothly.
-
Pay any copays you owe. Pay other costs that are your responsibility.
-
Contact us if you have questions or concerns.
-
Tell us if your address, phone number, or contact information changes.
Fraud, waste, and abuse (FWA) can increase health care costs and affect member services.
Examples include:- Using someone else's member ID card
- Billing for services that were never provided
- Changing prescription information
- Providing false information about eligibility
Examples of Fraud, Waste, and Abuse
Claims:
- Double billing
- Billing for services not provided
- Submission of false documents
- Billing non-covered services as covered
Member:
- Identity theft
- Doctor shopping
- Prescription stockpiling
- Misrepresentation of eligibility or medical condition
For potential Fraud-Waste-Abuse complaints, you may call our Compliance Alert Line
All Medicare Advantage plan organizations, like Health Choice Pathway, must obey federal laws against retaliation. If you report fraud, waste, and abuse to us, it will not affect the medical care you receive.
If you witness any instances of Medicare fraud, waste, or abuse, please call the Compliance Alert Line, toll-free at 1-800-237-0916 (TTY 711), 24 hours a day, 7 days a week. You can call this number any time and leave a confidential message.
Please leave a detailed message with the following information:
- Your name – please state whether you are a member, provider, or employee of our plan
- Telephone number
- Include all information that supports the referral
You may remain anonymous. Your call will receive the same attention whether you identify yourself or not.
- Sometimes you may need help understanding your plan or making health care decisions. If this happens, you have the right to ask someone such as a family member or friend to help you with decisions about your healthcare.Use this form to choose someone you trust to act on your behalf. If you decide that you want to appoint someone to speak on your behalf, please fill out the form below and return it to us by either faxing to 1-480-784-2933 or by mail to:
Health Choice Pathway
8220 N. 23rd Avenue
Phoenix, AZ 85021Please make a copy and keep for your records before mailing or faxing it to us. If you have questions about appointing someone to speak or make healthcare decisions on your behalf, please call us.
Appointment of Representative Form
Appointment of Representative Form (Spanish) - We only share health information when you give us permission. Use this form if you want us to share your health information with another person.
If you decide that you want to appoint someone who we can disclose personal health information on your behalf, please fill out the form below and mail or fax your form to:Health Choice Pathway
8220 N. 23rd Avenue
Phoenix, AZ 85021
Fax: 480-760-4635Please make sure you make a copy and keep for your records before mailing or faxing it to us.
If you have questions about appointing someone to speak or make healthcare decisions on your behalf, please call us.
Authorization to Disclose PHI Form
Authorization to Disclose PHI Form (Spanish) As one of our valued members, we have you covered if the Governor, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or state of emergency in our service area.
During a disaster or emergency, getting care may be harder. We will help you get covered services.If you are affected by a declared state of disaster or state of emergency, we will:
-
During an emergency, you may get covered care from out-of-network providers. Your costs will stay the same. Providers must be Medicare certified.
- Waive applicable medical prior authorization requirements in full.
- Allow members to fill their prescriptions at a non-network pharmacy. We will waive the one-time fill restriction should the state of disaster or state of emergency exceed thirty days. You will pay the normal out-of-network differential cost in addition to your designated copay or coinsurance.
- Permit members to refill prescription medications even if it is too soon for a refill. We will also override prior authorization, step therapy, and quantity limit restrictions for up to 90 days or until the declared state of disaster or state of emergency ends.
Your expanded access to non-network providers and facilities will end when one of the following conditions are met:
- If thirty days have elapsed since the declaration of the public health emergency or state of disaster, and no end date was identified by the original source or the Centers for Medicare and Medicaid Services (CMS), it will be considered the end of the disaster.
- The source that declared the public health emergency or state of disaster declares an end.
- CMS declares an end of the public health emergency or state of disaster.
-
If you become very sick or injured, you may not be able to make your own health care decisions. Federal and Arizona law protect your right to plan ahead and let others know your wishes.
An Advance Directive is a legal document that explains your health care wishes if you cannot speak for yourself. It can also name someone you trust to make health care decisions for you.
Types of Advance Directives
Arizona recognizes four main types of Advance Directives:
- Living Will
- Health Care Power of Attorney
- Mental Health Care Power of Attorney
- Prehospital Medical Care Directive (Do Not Resuscitate)
Living Will
A Living Will tells your doctors what kind of medical care you want if you become seriously ill and cannot make decisions for yourself.
For example, it can explain whether you want:
- A breathing machine (ventilator)
- Tube feeding or other artificial nutrition and hydration
- Other treatments that may prolong your life
Health Care Power of Attorney
A Health Care Power of Attorney lets you choose another adult to make health care decisions for you if you cannot make them yourself. This person is called your agent. Choose someone you trust who understands your wishes and is willing to speak on your behalf.
Mental Health Care Power of Attorney
A Mental Health Care Power of Attorney allows you to name someone to make decisions about your mental health treatment if you are unable to make those decisions yourself.
Prehospital Medical Care Directive (DNR)
A Prehospital Medical Care Directive tells emergency medical personnel that you do not want certain lifesaving treatments if your heart stops beating or you stop breathing. You can get a free copy of this form by calling the Bureau of Emergency Medical Services at 602-364-3150.
Making Your Advance Directive Legal
To make an Advance Directive valid in Arizona, you must:
- Understand what you are signing
- Sign and date the document
- Have your signature either:
- Witnessed by a qualified adult witness, or
- Notarized by a Notary Public.
The witness cannot be:
- Your health care provider
- The person you name as your agent
- A person involved in paying for your health care
- A person who may inherit your property, unless they are related to you by blood, marriage, or adoption
If you cannot sign your name, another person may sign for you if you direct them to do so and they sign in your presence.
After You Complete Your Advance Directive
Once your forms are completed:
- Keep the original documents in a safe place.
- Give copies to your doctor, hospital, health care agent, and family members or others who may be involved in your care.
- Talk to your loved ones about your wishes.
- Review your forms from time to time and update them if your wishes change.
- If you create a new Advance Directive, provide copies to everyone who received the previous version.
If you have questions about your right to make health care decisions, please call us.
To read more on Arizona state laws on Advance Directives, visit Life Care Planning | Arizona Attorney General (azag.gov)
You may also contact:
Arizona Division of Aging and Adult Services
1789 W. Jefferson, Site Code 950A
Phoenix, AZ 85007
Phone: (602) 542-4446Your local Area Agency on Aging or senior center may also have forms and information to help you complete an Advance Directive.
Nurse Advice Line
Available 24/7
Trusted help from a nurse any time, day or night.
If you need general medical advice, please call our 24-hour Nurse Advice Line. at Our highly trained nurses are available 24 hours a day, 7 days a week to help you.
If you have a medical emergency, please call 911 immediately.