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Advance Directives

Advance directives are documents that allow you to make your wishes about end-of-life care known ahead of time, including who you
want to make healthcare decisions for you, should you ever become unable to speak for yourself.

picture_as_pdf Utah Advance Directives Form

picture_as_pdf Utah Formularios de Directivas Anticipadas

picture_as_pdf Idaho Advance Directives Form

picture_as_pdf Idaho Formularios de Directivas Anticipadas

picture_as_pdf Nevada Advance Directives Form

picture_as_pdf Nevada Formularios de Directivas Anticipadas

picture_as_pdf Colorado Advance Directives Form

picture_as_pdf Colorado Formularios de Directivas Anticipadas

Advance directives include the following properly executed documents:

Living Will
Durable Power of Attorney for Healthcare
Written statements expressing a patient's wishes regarding treatment and/or end-of-life care
Patient statements regarding treatment and/or end of-life care documented in the medical record

It is important to understand the options available to you for advance directives and your rights under state law. Select Health and our
network of hospitals and providers are required to comply with state law and cannot refuse care or otherwise discriminate against you
based on whether or not you have a properly executed advance directive. If you don't have advance directives on file, this information will be provided to you upon request.

Who should have advanced directives?

We encourage you to discuss your wishes with family members and healthcare providers, and to complete advance directives prior to receiving care or being hospitalized. When you provide a copy of your advance directives to provider, they are required to keep the
documents in your medical record and refer to them when determining a course of treatment. You may change your advance directives
simply by giving your provider a new Living Will and Durable Power of Attorney for Healthcare. To cancel or revoke your advance directives, you should communicate your wishes in writing to your healthcare provider.

What is an advance directive? Why does it matter? Get answers.

Where can I find additional information?

Ensuring that you understand your rights with regard to advance directives is very important to us. To help you, our staff has received
special training and education about the policies and procedures for advance directives. We also provide related community education.
For more information about advance directives, please call or visit the appropriate phone number or website listed below:

Intermountain Health: toll-free 800-442-4845 or advance planning.
St. Luke's Health System: 208-381-2616 or advance directives.

If you have given your healthcare provider a signed advance directive, and you believe your healthcare provider has not followed your instructions, you may file a complaint

Utah

link Utah State Department of Health

link Utah Department of Public Licensure

Idaho

link The Office of the Attorney General for the State of Idaho

Nevada

link Nevada Secretary of State

Colorado

link Colorado Department of Public Health and Environment

Ask your nurse or doctor for more information about advance directives

Medicare Disclaimers

Select Health is an HMO, PPO, SNP plan sponsor with a Medicare contract. Enrollment in Select Health Medicare depends on contract renewal.

Every year, Medicare evaluates plans based on a 5-Star Rating System. Select Health Medicare HMO plans received 4 out of 5 Stars and Select Health Medicare PPO plans received 3.5 out of 5 Stars for the contract year 2025. Visit medicare.gov for more information.

The benefits mentioned are part of a special supplemental program for chronically ill enrollees. Eligible chronic conditions include diabetes, hypertension, musculoskeletal disorders, lung disorders, and cancer, as well as other conditions not listed. Eligibility for the benefits is not based solely on your condition and all eligibility requirements must be met before the benefits are provided. For details, please contact the Plan.

Select Health Medicare + Kroger pharmacy network includes limited lower-cost, preferred pharmacies in Bonneville county in Idaho. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 855-442-9900 (TTY:711) or consult the online pharmacy directory at www.selecthealth.org/medicare/pharmacy.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
For accommodations of persons with special needs at meetings, call member services at 855-442-9900 (TTY:711).

If you have a compliance concern, or suspect fraud, waste or abuse is occurring, contact Compliance at 800-442-4845 (TTY 711), available 24/7 or email ContactCompliance@imail.org. For anonymous reporting, please call 844-442-5844 (TTY 771), where a third-party vendor will collect and report your concern.

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Advance Directives

Who should have advanced directives?

Where can I find additional information?

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Medicare Disclaimers

Advance Directives

Who should have advanced directives?

Where can I find additional information?

Important Links

Helpful Links

Notices

Contact Us

Medicare Disclaimers

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