AmeriHealth 65^® Basic

Policies & Forms

Policies

Privacy Practices
Your right to the privacy of your medical records and personal health information.

Your Rights and Responsibilities
Your Rights and Responsibilites as a member of AmeriHealth 65.

AmeriHealth 65 Plus Eligibility requirements
Find out if you are eligible to enroll in an AmeriHealth 65 Plus (NJ) Medicare Part D prescription drug plan.

AmeriHealth 65 Basic Eligibility requirements
Find out if you are eligible to enroll in an AmeriHealth 65 Basic Medicare Part D prescription drug plan.

Disenrollment
Leaving AmeriHealth 65 and your choices for continuing Medicare after you leave.

Formulary Changes
Can your prescription drug formulary list change during the year?

Filling prescriptions outside the network
Rules about filling a prescription when you are outside the network.

Forms

Authorization to Release Information
This form is used to release your Protected Health Information (PHI) as required by federal and state privacy laws.

Personal Representative Request Form
This form identifies the person who has legal authority to act on a member's behalf in making decisions related to the member's health care.

H3156