2024 Member Resources & Forms
2024 Evidence of Coverage
2024 Summary of Benefits
2024 Benefits Beyond Medicare
2024 Forms & Documents
2024 Appeals & Grievances
Evidence of Coverage
Learn about evidence of coverage for Arizona and Florida for each Gold Kidney Health Plan.
2024 Summary of Benefits
Super Plus/Super Complete
For those with cardiovascular disorders, chronic heart failure, and/or diabetes. Super Plus is designed for Medicare members and Super Complete is designed for members with Medicare and Medicaid.
Dialysis Plus/Dialysis Complete
For those with End-Stage Renal Disease (ESRD) requiring any mode of dialysis. Dialysis Plus is designed for Medicare members and Dialysis Complete is designed for members with Medicare and Medicaid.
Essential Care
For those with existing prescription drug coverage who need only a few supplemental benefits.
Gold Circle
For those with cardiovascular disorders, chronic heart failure, and/or diabetes and who is looking for a plan similar to original Medicare with additional food and fuel benefits.
Honest Care
For those without chronic conditions who are seeking a plan with extra benefits and the flexibility to see the doctor of their choice with no referral required.
Loyalty Care
This medical plan is for people who have separate prescription drug coverage.
2025 Annual Change of Notice (ANOC)
2024 Benefits Beyond Medicare
Flex Card Benefits
Our Medicare Advantage plans include dental, hearing, vision, and more. Members are able to choose their providers without being concerned about whether they are in or out of network.
Flex card benefits include:
- Dental, hearing and vision
- Rewards and incentives
- Special supplemental benefits for the chronically ill
- Over-the-Counter (OTC) medication
Members receive a quarterly allowance for benefits. Generally, quarterly allowance balances do not roll from quarter.
Transportation
Gold Kidney provides transportation benefits through an easy-to-use app that can be used for scheduling trips, or requesting on-demand trips.
Gold Kidney provides non-emergency transportation options for members with various mobility needs. Members can call or use an app on their phone to manage all their transportation needs, including the following services:
- Curb to curb
- Door to door
- Hand to hand
- Wheelchair
- Stretcher
- Non-emergency ambulance
No prior authorization is required, and one companion is allowed to accompany our members.
Companion Care
Our member benefits include support for everyday tasks or companionship needs.
We help connect members and their families to individuals who can provide companionship or help with everyday chores and tasks like grocery shopping, light housekeeping or yardwork, and technology assistance.
Fitness
Gold Kidney offers the most comprehensive exercise and healthy aging programs available in the market through Silver&Fit.
Gold Kidney has partnered with Silver&Fit to provide members with a variety of exercise and well-being options, including:
- Fitness center memberships – at gyms, exercise studios, and outdoor fitness programs
- Virtual personal training and home fitness kits
- Digital well-being resources and in-person healthy aging classes
Meal Delivery
Gold Kidney offers meals to help those with chronic conditions manage their conditions or those recovering from a hospital stay.
Home–delivered meals, designed by professional chefs and registered dieticians, for members who need help managing the nutritional aspects of their health conditions or who may need assistance with meals after surgery or hospital stay. Two meals per day for 14 days up to 4 times per year.
Personal Emergency Response System
Gold Kidney provides a device for the member to be immediately connected with professionally trained operators who quickly assess the nature of a call and coordinate appropriate assistance.
- Dispatch Center
- Emergency Medical Services (EMS)
- 24/7 Nurse Line
- Case Management
- Customer Service Support
- Family and Caregiver Notifications
Nurse Advice Line
A dedicated service staffed by qualified and experienced nurses who provide medical assistance and guidance over the phone when members need it.
Nurse Advice Lines are available 24/7 to help answer your questions or provide triage and referral services.
Remote Patient Monitoring
Gold Kidney offers remote patient monitoring services to remotely manage chronic health conditions from the comfort of our members’ homes.
Gold Kidney offers a platform that Includes an AI virtual health assistant, and clinical Insights and analytics that provide more Informed clinical decision-making, earlier Interventions, and better care.
The monitored services can include a weight scale, blood pressure cuff, glucose monitor, and pulse oximeter.
Transplant Services
Gold Kidney offers access to transplant Centers of Excellence.
Through our partners, we assess a member’s condition and coordinate care with providers to ensure the best opportunities for transplant success. Learn about our transplant network.
2024 Forms & Documents
Enrollment Form
Click here to sign up for one of our Medicare Advantage plans.
Condition Verification C-SNP Form
Pre-Enrollment Checklist
Find a list of everything you will need to have on hand before enrolling.
Member Attestation Form
Health Risk Assessment (HRA) Form
Premium Payment Authorization Form
Complete this form to authorize the automatic deduction of premium payments from your Social Security or Railroad Retirement Board benefit check.
Member Reimbursement Forms
Use this when you are seeking reimbursement for out-of-pocket expenses you’ve incurred for covered services.
Medication Therapy Management (MTM)
For those in a Medicare drug plan that have complex health needs.
Formulary Drug List
A drug formulary is a list of covered prescription medications.
Disenrollment Rights & Responsibilities
Learn your rights and responsibilities to disenroll from Gold Kidney Health Plans.
