Enrollment Form This form is provided as a reference. If you are interested in joining the HeartLine Plus plan, please call DAKOTACARE at 1-800-356-0554. TTY users should call 711 or 1-800-877-1113. We are open 8:00 AM to 8:00 PM 7 days a week. pdf (234k)

Evidence of Coverage pdf (587k)

HeartLine Plus Comprehensive Health Exam Form HeartLine Plus Comprehensive Health Exam Form pdf (61k)

HIPAA Privacy Notice pdf (62k)

Formulary pdf (405k)

Low Income Subsidy Chart xls (19k)

Pharmacy Directory pdf (188k)

Prescription Drug Claim Form pdf (82k)

Quality Assurance/Utilization Management Policy & Procedure for Medical Therapy Management Program pdf (60k)

Request for Medicare Prescription Drug Coverage Determination pdf (37k)

Summary of Benefits pdf (175k)

This page was last updated on 2/05/2008.