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Request Medicare Member Materials

To request a hard copy of an Evidence of Coverage (EOC), Delta Dental Certificate of Insurance (COI), provider directory, formulary or Annual Notice of Changes (ANOC), please fill out the form below and we will send it to you.

What materials are you requesting? (select all that apply)
["https://enterprise.sapphirethreesixtyfive.com/?ci=SummaCareMedicare","https://enterprise.sapphirethreesixtyfive.com/?ci=SummaCareMedicare&network_id=15&geo_location=&locale=en","https://summacareweb.healthsparq.com/healthsparq/public/#/one/insurerCode=SCCR_I&brandCode=SCCR&productCode=PRODMC&postalCode","https://summacareweb.healthsparq.com/healthsparq/public/#/one/insurerCode=SCCR_I&brandCode=SCCR&productCode=PRODMC&postalCode=","https://summacareweb.healthsparq.com/healthsparq/public/#/one/insurerCode=SCCR_I&brandCode=SCCR&productCode=PRODMK&postalCode=","https://enterprise.sapphirethreesixtyfive.com/?ci=SummacareIndividual-Family","https://client.formularynavigator.com/Search.aspx?siteCode=3822601471","https://client.formularynavigator.com/Search.aspx?siteCode=7139238863","https://client.formularynavigator.com/Search.aspx?siteCode=3184374974","https://openenrollment.medimpact.com/#/plancode?SUM032021PL","https://openenrollment.medimpact.com/#/web/sum/pharmacy"]
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[{"RootId":"a7b694b6-2900-400a-abd1-35cff4b9f3ce","RootUrl":"/medicare/understanding-medicare/glossary/"},{"RootId":"bb4c888a-5dd6-4576-bf4c-88afff4f77ef","RootUrl":"/medicare/understanding-medicare/faqs/"}]