Have an Enrollment need? Call us at 1-877-687-1196 (Relay Texas/TTY 1-800-735-2989). Learn More.
Member Materials and Forms
Member Resources
Many of our member resources, such as the member handbook and forms, can be found by logging into your online member account. Click Login to create an account and access a wide array of resources!
Member Handbook
Reference Materials
- Advance Directives
- Doctor’s Office Visit Checklist (PDF) - Use this checklist to get prepared for your next doctor’s appointment.
- Find a Provider Guide (PDF)
- myStrength Behavioral Health Resource (PDF)
- Preventive Services Guide (PDF)
- Quality Improvement (QI) Program
- Statement of Non-Discrimination
- 2020 Transparency Notice
- 2019 Transparency Notice
- Where To Go For Care
- Women's Health and Cancer Rights Act Annual Notice
- Notice of Certain Mandatory Benefits
Forms
- Inform Ambetter of a Balance Bill
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization to Disclose Health Information Form (PDF)
- Complaints Form (PDF)
- MAXIMUS Appointment of Representative Form (PDF)
- MAXIMUS External Review Request Information Form (PDF)
- Member Reimbursement Medical Claim Form (PDF) - Used to submit a paid claim for Out of Country emergency services received from an out-of-network international provider.
- Prescription Claim Reimbursement Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)
Please check our Find a Provider page for the most current provider listings.