This packet includes forms required to enroll in Lasso Healthcare MSA.
DownloadThis document provides existing Lasso Healthcare MSA members with the changes for the upcoming benefit year.
DownloadLasso Healthcare MSA agent sales presentation.
DownloadThis booklet gives you the details about your Medicare health coverage.
DownloadMembers can use these Star Ratings to compare our plan’s performance to other plans.
DownloadA brief overview of benefits, eligibility, availability, and other plan information.
DownloadEarn up to $250 in gift card rewards via our For Your Health program! All members are mailed a personalized packet of instructions, activity forms and reward request forms. The generic forms included in this PDF may also be used.
Coming soon!
2020 Lasso Healthcare agent sales presentation.
DownloadThis packet includes forms required to enroll in 2020 Lasso Healthcare MSA.
DownloadThis booklet gives you the details about your Medicare health care coverage from January 1 – December 31, 2020.
DownloadEarn up to $250 in gift card rewards via our 2020 For Your Health program! All members are mailed a personalized packet of instructions, activity forms and reward request forms shortly after their coverage effective date. The generic forms included in this PDF may also be used.
DownloadA brief overview of 2020 benefits, eligibility, availability and other plan information.
DownloadLasso Healthcare does not discriminate on the basis of race, color, national origin, sex, age, or disability.
DownloadThis form is used by agents to transfer a partial or full book of business to another agent.
DownloadThis form is used by members to request a change to their agent.
DownloadThis form is used by members to request disenrollment. Members may disenroll only during AEP (10/15-12/7) or other limited circumstances.
DownloadMember application for payment consideration when payment was made directly to provider.
DownloadThis notice describes how medical information about you may be used and disclosed and how you can get access to this information.
DownloadThis notice is sent to members when additional information is needed to open the MSA account.
DownloadInformation regarding newly opened Optum Bank MSA accounts.
DownloadThis form is used by providers to request a recoupment from a future remittance or to send a voluntary refund check for a claims overpayment.
DownloadA brief guide for providers to understand how MSA clinical access rules are the same as Original Medicare.
DownloadInformation, rights, and responsibilities upon discontinuing enrollment.
DownloadThis card is sent to members to access their Lasso Healthcare MSA benefits.
DownloadThis card is sent to members to access their MSA funds.
DownloadThis document is required for an agent to present a Medicare Advantage Plan prior to a one-on-one meeting whether face to face or over the phone.
DownloadContact information for each State Health Insurance Assistance Program (SHIP) in our service area, which provides free help regarding health insurance to Medicare beneficiaries.
DownloadThis form is required by CMS to be submitted by a provider who is filing a standard appeal for a denied claim.
DownloadAn informative booklet for new members to understand how the Lasso Healthcare MSA plan works.
Download