Medicare Materials Order Form:
Contact Information
*First Name:
*Last Name:
*Address 1:
Address 2:
*City:
*State:
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Additional Details
Email:
Select a Directory:
(2025 Directory includes all 2026 providers)
Select one
September Provider Directory Space Coast (Brevard, Indian River)
October Provider Directory Greater Daytona (Volusia, Flagler)
September Provider Directory Orlando/Central Florida (Lake, Orange, Seminole, Osceola)
September Provider Directory Tampa (Hardee, Highlands, Hernando, Pasco, Polk)
Formulary:
Select one
September Health First Formulary
Evidence of Coverage:
Select one
2025 Health First Classic (HMO-POS) H1099-001
2025 Health First Rewards (HMO) H1099-014
2025 Health First Secure (HMO) H1099-009
2025 Health First SunSaver (HMO) H1099-016
2025 Health First Value (HMO) H1099-006
2025 Health First Emerald Plus (HMO) H1099-024
2025 Health First Emerald Plus (HMO) H1099-026
2025 Health First Complete Care (HMO) H1099-023
2025 Health First Easy Access (HMO) H1099-025
2025 Health First Easy Access (HMO) H1099-027
2026 Health First Classic (HMO-POS) H1099-001
2026 Health First Rewards (HMO) H1099-014
2026 Health First Secure (HMO) H1099-009
2026 Health First SunSaver (HMO) H1099-016
2026 Health First Value (HMO) H1099-006
2026 Health First Emerald Plus (HMO) H1099-024
2026 Health First Emerald Plus (HMO) H1099-026
2026 Health First Emerald Plus (HMO) H1099-028
2026 Health First Complete Care (HMO) H1099-023
2026 Health First Premier Access (HMO) H1099-025
2026 Health First Premier Access (HMO) H1099-027
Summary of Benefits:
Select one
2025 Summary of Benefits Secure
2025 Summary of Benefits Classic, Value, Rewards
2025 Summary of Benefits Sunsaver, Easy Access
2025 Summary of Benefits Emerald Plus, Easy Access, Complete Care
2025 Summary of Benefits Emerald Plus - Indian River County
2026 Summary of Benefits Secure (009)
2026 Summary of Benefits Classic (001), Value (006), Rewards (014)
2026 Summary of Benefits SunSaver (016) (Hardee)
2026 Summary of Benefits Emerald Plus (024), Premier Access (025), Complete Care (023) (Hernando, Lake, Orange, Osceola, Polk, Pasco, Seminole)
2026 Summary of Benefits Emerald Plus (026) (Indian River)
2026 Summary of Benefits Premier Access (027), SunSaver (016), Emerald Plus (028) (Volusa, Flagler, Highlands)
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