Viva Medicare Infirmary Health Advantage (HMO)
Forms and Resources

• 2025 Infirmary Health Advantage Copay Sheet
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• 2025 Infirmary Health Advantage Summary of Benefits
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• 2025 Viva Medicare Infirmary Advantage Evidence of Coverage
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• 2025 Viva Medicare Infirmary Advantage Annual Notice of Change
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• 2025 Viva Medicare Plus, Premier, Prime, Extra Value, Classic, Extra Care, and Infirmary Health Advantage Plans Pharmacy Directory
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• 2025 Viva Medicare Plus, Prime, Premier, Classic and Infirmary Health Advantage Plans Formulary (List of Covered Drugs)
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• Diabetic Testing Supply Information
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• Advance Directive for Health Care
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• Reimbursement Claim Form
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• Non-Discrimination Notice and Language Accessibility Services
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• 2025 Medicare Star Rating
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• 2025 Over-the-Counter (OTC) Catalog
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• 2025 Silver&Fit Program Information
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• 2025 Hearing Aid Coverage
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• 2025 Enrollment Application
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