Member Important Documents
CCA Health Rhode Island will no longer offer Medicare plans in 2025, but you can find previous plan documents here.
CCA Medicare Advantage Plans | CCA Medicare Maximum | Member Forms | Member Rights
CCA Medicare Advantage Plan Benefit Documents
CCA Medicare Preferred (PPO) (RI) – Evidence of Coverage (2024)
A detailed document to explain how your Medicare Preferred plan works and what care and services are covered.
CCA Medicare Value (PPO) (RI) – Evidence of Coverage (2024)
A detailed document to explain how your Medicare Value plan works and what care and services are covered.
CCA Medicare Maximum (HMO D-SNP) Benefit Documents
CCA Medicare Maximum (HMO D-SNP) (RI) – Evidence of Coverage (2024)
A detailed document to explain how your CCA Medicare Maximum works and what care and services are covered.
CCA Member Forms
CCA Member Reimbursement Form
Vision Reimbursement Form
Appointment of Representative Form
Release of Information (ROI) Form
This form is used to release your health information from CCA to a person or organization. It can also be used to request your health information from a person or organization, such as a healthcare provider or hospital, to be shared with CCA.
CCA Medicare Advantage Plans (RI) – Prescription Reimbursement Form
CCA Medicare Dual Special Needs Plan RI – Prescription Reimbursement Form
CCA Member Rights
Your Rights as a Member – CCA RI Medicare Preferred and Value (PPO)
Your Rights as a Member – CCA Health RI Medicare Maximum (HMO D-SNP)
Member Release of Records Form
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