Viva Medicare Extra Value (HMO SNP)
Forms and Resources

• 2025 Extra Value Copay Sheet
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• 2025 Extra Value Summary of Benefits
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• 2025 Viva Medicare Extra Value Evidence of Coverage
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• 2025 Viva Medicare Extra Value Annual Notice of Change Full Duals
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• 2025 Viva Medicare Extra Value Annual Notice of Change Partial Duals
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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 Extra Value and HH Extra Care 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) and Grocery Catalog
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• Catálogo de Productos de 2025
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• 2025 Silver&Fit Program Information
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• 2025 Hearing Aid Coverage
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• Viva Medicare Transportation Benefit Guide
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• Flex Card 2025
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• 2025 Enrollment Application
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