Viva Medicare Select (HMO)
Forms and Resources

• 2024 Enrollment Application
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• 2024 Select Copay Sheet
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• 2024 Select Summary of Benefits
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• 2024 Viva Medicare Select Evidence of Coverage
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• 2024 Viva Medicare Select Annual Notice of Change
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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
  View PDF →
• 2024 Medicare Star Rating
  View PDF →
• 2024 Silver&Fit Program Information
  View PDF →
• 2024 Hearing Aid Coverage
  View PDF →
• 2024 Over-the-Counter (OTC) Catalog
  View PDF →