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!

Reference Materials

• Transparency Notice
• Statement of Non-Discrimination
• Find a Provider Guide (PDF)
• Ambetter Preventive Guide

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