Sage Memorial Plan Documents

Here you’ll find the Sage Memorial Hospital documents and forms you need in Adobe PDF format. Don’t have Adobe Reader? Get it here

Sage Memorial Hospital Health Plan Documents

Summary of Benefits & Coverage (SBC) Download PDF	SBC Glossary Download PDF
Plan Document Download PDF

Helpful Documents and Forms

HIPAA Authorized Representative Form Download PDF	Enrollment Form Download PDF
Medicare Part D Notification Download PDF	Coordination of Benefits (COB) Questionnaire Download PDF
Explanation of Benefit (EOB) Example Download PDF