Plan Documents - Healthy Mississippi, Inc.

We offer complimentary forms and resources to assist with any inquiries you may have. Feel free to download and store this documentation on your computer or device for future reference.

Member Resources

2026 Summary of Benefits
2026 Evidence of Coverage
2026 Provider Directory
2026 HM Formulary
2026 Pharmacy Directory
2026 Prior Authorization List
2026 HM Member Kit
HMI Dental Portal – Help

A beneficiary enjoys a cup of coffee while chatting online with an agent about her Medicare options.

A happy couple enjoying their time with their beloved pets after completing their enrollment with Healthy Mississippi, Inc.

Member Forms

2026 HM Enrollment Form
HM Disenrollment Form
2026 HRA Form
Mail Order Pharmacy Form
Appeals Form
Grievances Form
Medical Redetermination Request Form
2026 Scripius Part D Coverage Determination Request Form
2026 Scripius Part D Redetermination Request Form
Appointment of Representative Form

Member Education

High Blood Pressure

Happy boy grandson reading book with old senior man grandfather at home

Senior couple meeting financial adviser for investment, looking at laptop in office

Request Materials

If you would like to request hard copies of the plan documents, please fill out the form on our Request Materials page or by calling Member Services at (833)-201-6413 TTY:711. You can reach us 8AM – 8PM CST 7 days/week from October 1 to March 31, and Monday through Friday from April 1 to September 30.