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! We’ve also provided a few resources below.

Member Handbook

• 2020 Ambetter Member Handbook (PDF)
• 2019 Ambetter Member Handbook (PDF)

Reference Materials

• Advance Directives
• Authorization to Disclose Health Information Form & Revocation of Authorization Form - English (PDF) 
• Authorization to Disclose Health Information Form & Revocation of Authorization Form - Spanish (PDF)
• Authorization to Disclose Health Information Form & Revocation of Authorization Form - Chinese (PDF)
• Authorization to Disclose Health Information Form & Revocation of Authorization Form - Russian (PDF)
• Authorization to Disclose Health Information Form & Revocation of Authorization Form - Vietnamese (PDF)
• Doctor's Office Visit Checklist (PDF) - Use this checklist to get prepared for your next doctor's appointment. 
• Find a Provider Guide (PDF)
• Get Your Flu Shot
• Helpful Links
• Grievance and Appeal Process (PDF)
• List of Covered Preventive Services
• Member Rights & Responsibilites (PDF)
• Notice of Privacy - English (PDF)
• Notice of Privacy - Spanish (PDF) 
• Notice of Privacy - Chinese 
• Notice of Privacy - Korean (PDF) 
• Notice of Privacy - Russian (PDF) 
• Notice of Privacy - Vietnamese (PDF)
• Preventive Services Guide (PDF)
• Quality Improvement (QI) Program
• Referral and Authorization Information
• Statement of Non-Discrimination
• Where To Go For Care
• Women's Health and Cancer Rights Act Annual Notice

Forms

• Authorization to Disclose Health Information Form (PDF)
• Revocation of Authorization Form (PDF)
• Member Grievance and Appeal 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.
• Pharmacy Program Forms
• Prescription Claim Reimbursement Form (PDF)
• Donor Transplant Travel Reimbursement Form (PDF)
• Recipient Transplant Travel Reimbursement Form (PDF)
• Member Transplant Travel Reimbursement Policy (PDF)