Member Resources
Many of our member resources, such as the member handbook and forms, can be found on our secure portal. Click Login to create an account and access a wide array of resources!
Member Handbook
Reference Materials
- Transparency Notice
- Statement of Non-Discrimination
- Find a Provider Guide (PDF)
- Ambetter Preventive Guide
- Where to go for Care
Forms
- 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)
- Transplant Reimbursement Form (PDF)
- PA Insurance Department Complaint Form