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Benefits Beyond Medicare

2026
2025

Forms &
Documents

2026
2025

Plan Documents

Access your Annual Notice of Change, Evidence of Coverage, and Summary of Benefits on our website or in the Gold Kidney member portal

Go To Plan Documents
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2026 Benefits Beyond Medicare

Visit our Gold Kidney Member Portal for detailed information on your plan benefits.

Dental

Annual coverage amount for preventive and comprehensive dental services

Hearing

Routine hearing exam, fitting and evaluation for prescription hearing aids, and 3-year warranty for hearing aids

Vision

Routine eye exams and annual amount for routine eyewear or contact lenses

Transportation

Routine transportation to plan-approved health-related locations

2026 Forms & Documents

Enrollment

Chronic Condition Verification Form: English | Spanish

To Enroll, visit our enrollment page

Coverage, Membership, and Benefits​

Authorized Representative Form: English | Spanish

Health Risk Assessment (HRA) Form: English | Spanish

HMO-POS FAQs: English | Spanish

Medication Therapy Management (MTM): Learn More

MultiPlan Information: Learn More

Member Reimbursement Form (Medical): English | Spanish

Member Reimbursement Form (Supplemental Benefit): English | Spanish

Premium Payment Authorization Form: English | Spanish

Prior Authorization Form (Part C): English | Spanish

Transplant Centers of Excellence (AZ): English | Spanish

Transplant Centers of Excellence (FL): English | Spanish

2025 Benefits Beyond Medicare​

Visit our Gold Kidney Member Portal for detailed information on your plan benefits.

Smartphone

Smartphone with unlimited plan for easier access to care resources

Nurse Advice Line

Nurse care line access to assist with health-related questions, care coordination, and more

Fitness

Access to fitness locations, fitness kits, and online resources and support

Gold Perks & Gold Perks Plus

Monthly allowances to use toward products and services such as over-the-counter items, fitness activity fees, and home and bathroom safety devices

2025 Forms & Documents

Enrollment

Chronic Condition Verification Form:

Chronic Conditions including Diabetes

Chronic Conditions including ESRD

To Enroll, visit our enrollment page

Coverage, Membership, and Benefits​

Authorized Representative Form: English | Spanish

Health Risk Assessment (HRA) Form: English | Spanish

HMO-POS FAQs: Learn More

Medication Therapy Management (MTM): Learn More

Member Reimbursement Form (Medical): English | Spanish
Member Reimbursement Form (Supplemental Benefit): English | Spanish

Premium Payment Authorization Form: English

Prior Authorization Form (Part C): English | Spanish

Transplant Centers of Excellence (AZ): English | Spanish

Transplant Centers of Excellence (FL): English | Spanish

Appeals

Learn more

Grievances & Coverage Decisions

Learn more

Low Income Subsidy Summary

Learn more

Disenrollment Rights & Responsibilities

Learn your rights and responsibilities to disenroll from Gold Kidney Health Plans.

Learn more
Contact Us

HQ Location
4600 E Washington St, #300
Phoenix, AZ 85034

Mailing Address
P.O. Box 285
Portsmouth, NH 03802

(844) 294-6535 (TTY 711)
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Hours of Operation

7 days a week
8am – 8pm local time (except holidays)

Gold Kidney Health Plan, Inc., is an HMO-POS and HMO-POS C-SNP with a Medicare contract.
Enrollment in Gold Kidney Health Plan depends on contract renewal.
Last Updated: Oct. 1, 2025 | Y0171_GKHPWebsite_M | Copyright © 2025 Gold Kidney Health Plan
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For all inquiries, please call Member Services at (844) 294-6535

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Enrollment applications for our 2026 Medicare Advantage plans will be available beginning on October 15th.
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