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Handbooks & Forms for Members | Ambetter from PA Health & Wellness
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- Transparency Notice 2020
- Transparency Notice 2019
- Statement of Non-Discrimination
- Find a Provider Guide (PDF)
- Preventive Services Guide (PDF)
- Where to go for Care
- Dr. Office Visit Checklist (PDF)
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization to Disclose Health Information Form (PDF)
- Grievance & Complaint Form (PDF)
- Member Reimbursement Medical Claim Form (PDF)
- Prescription Claim Reimbursement Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)
- PA Insurance Department Complaint Form