Request an Evidence of Coverage (EOC)

Please fill in your details below to request an Evidence of Coverage for Medicare (EOC). If you would prefer to download a PDF version, click below to view our Important Plan Documents page where you can download a copy immediately.

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In case we have any questions about your request, how can we contact you?

At EmblemHealth we are always looking for ways to provide better service to you.

If you are a non-member and want to request an Evidence of Coverage (EOC), you may call Customer Service at 1-877-344-7364 (TTY: 711),7 days a week, from 8:00 am to 8:00 pm.

For Members: I understand that the phone numbers I provided on this form may be used by EmblemHealth or any of its contracted parties to contact me about my account, my health benefit plan or related programs, or services provided to me.

For Non-Members: By completing this form, I consent to receive calls from a representative about EmblemHealth products and services at the number I have provided (including mobile devices). These calls may be made using an automated technology and my consent to receive these calls is not required as a condition for me to make a purchase.

Last Updated 01/01/19

Y0026_127476 Accepted 10/1/18