Viva Medicare Infirmary Health Advantage (HMO)
Forms and Resources

• 2022 Enrollment Application
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• 2022 Copay Sheet
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• 2022 Summary of Benefits
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• 2022 Viva Medicare Infirmary Health Advantage Evidence of Coverage
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• 2022 Viva Medicare Plus, Premier, Prime, Me, HH Classic, HH Preferred, and Infirmary Health Advantage Plans Pharmacy Directory
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• 2022 Viva Medicare Plus, Prime, Me, HH Classic and Infirmary Health Advantage Plans Formulary (List of Covered Drugs)
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• Diabetic Testing Supply Information
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• 2022 Over-the-Counter (OTC) Catalog
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• Advance Directive for Health Care
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• Non-Discrimination Notice and Language Accessibility Services
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• 2022 Medicare Star Rating
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• 2022 Silver and Fit Program Information
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• Reimbursement Claim Form
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• 2023 Hearing Aid Coverage
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