PacificSource Materials
What type of materials are you looking for?
Administrative forms for group insurance, including enrollment applications, continuation materials, and other forms:
Member materials including fliers and educational hand-outs intended for members:
Spanish language member materials:
Individual policy benefit summaries and application materials, including short term medical coverage:
Sales materials for group plans, including information about our company, our plan designs, and our programs and services:
Medicare Part D Notices
The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 added a voluntary prescription drug benefit (Part D) to the Medicare program, and “Part D eligible individuals” can enroll in this new prescription drug benefit. You may refer to our matrix of PacificSource pharmacy plans to determine if your pharmacy plan is creditable, and if so, which of the following communications apply to your group:
| A (creditable): | Employer notice | Sample member notice |
| B (noncreditable): | Employer notice | Sample member notice |
| C (noncreditable with special enrollment): | Employer notice | Sample member notice |
Unless otherwise stated, all text and images © 2006 PacificSource. All rights reserved.