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Member Materials and Forms | Ambetter from Superior HealthPlan
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!
Quick Reference Guide (QRG)
- 2023 Quick Reference Guide (QRG) (PDF)
- 2023 Quick Reference Guide (QRG) Off-Exchange (PDF)
- 2023 Quick Reference Guide (QRG) Value (PDF)
- 2023 Quick Reference Guide (QRG) Virtual (PDF)
- 2022 Quick Reference Guide (QRG) Essential, Balanced & Secure Care (PDF)
- 2022 Quick Reference Guide (QRG) Off-Exchange (PDF)
- 2022 Quick Reference Guide (QRG) Value (PDF)
- 2022 Quick Reference Guide (QRG) Virtual (PDF)
Reference Materials
- Member Health Library
- Advance Directives
- Doctor’s Office Visit Checklist (PDF) - Use this checklist to get prepared for your next doctor’s appointment.
- myStrength Behavioral Health Resource (PDF)
- Preventive Services Guide (PDF)
- Quality Improvement (QI) Program
- Statement of Non-Discrimination
- Balance Billing Disclosures - EPO
- Balance Billing Disclosures - HMO
- 2023 Transparency Notice - EPO
- 2023 Transparency Notice - HMO
- 2022 Transparency Notice - EPO
- 2022 Transparency Notice - HMO
- Where To Go For Care
- Women's Health and Cancer Rights Act Annual Notice
- Notice of Certain Mandatory Benefits
- Ambetter In-Network Hemophila Pharmacies
- Prior Authorization Requirements for Health Insurance Marketplace
- Ambetter In-Network Hemophilia Pharmacies
- Interoperability and Patient Access
- Find a Provider Guide (PDF)
- Cost Comparison Tool
- Wellness and Health Information
Forms
- Inform Ambetter of a Balance Bill
- Authorization to Disclose Health Information Form (Electronic)
- Authorization to Disclose Health Information Form - Chinese (PDF)
- Authorization to Disclose Health Information Form - Vietnamese (PDF)
- Revocation of Authorization to Disclose Health Information Form (PDF)
- Complaint Form - English (PDF)
- Complaint Form - Chinese (PDF)
- Complaint Form - Vietnamese (PDF)
- MAXIMUS Appointment of Representative Form (PDF)
- MAXIMUS External Review Request Information Form (PDF)
- Member Reimbursement Form - OTC Covid Test (PDF)
- Dental Reimbursement Form (PDF)
- Prescription Claim Reimbursement Form - English (PDF)
- Prescription Claim Reimbursement Form - Chinese (PDF)
- Prescription Claim Reimbursement Form - Vietnamese (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Donor Transplant Travel Reimbursement Form - Chinese (PDF)
- Donor Transplant Travel Reimbursement Form - Vietnamese (PDF)
- Recipient Transplant Travel Reimbursement Form - English (PDF)
- Recipient Transplant Travel Reimbursement Form - Chinese (PDF)
- Recipient Transplant Travel Reimbursement Form - Vietnamese (PDF)
- Member Transplant Travel Reimbursement Policy - English (PDF)
- Authorization Representative Designation Form (PDF)
- Member Reimbursement Medical Claim Form - English (PDF)
- Member Reimbursement Medical Claim Form - Chinese (PDF)
- Member Reimbursement Medical Claim Form - Vietnamese (PDF)
Please check our Find a Provider page for the most current provider listings. To request a current non-electronic (paper) listing of all Ambetter in-network providers at no cost, please contact Ambetter Member Services through the Online Member Portal, by email at SHPMSCONTACTUS@CENTENE.COM or by calling 1-877-687-1196 (Relay Texas/TTY 1-800-735-2989) from 8 a.m. to 8 p.m. CT, Monday through Friday.