Make it AmeriHealth, for coverage and services that meets your needs.

AmeriHealth® Advantage

Policies and forms

Policies

Exceptions and Appeals
Rules about what you need to do to make a complaint and what we are required to do when we receive a complaint.

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

Download PDF Your Rights and Responsibilities
See section 3 of the Evidence of Coverage for your rights and responsibilities as a member.

Download PDF Disenrollment
Leaving your plan, and your choices for continuing Medicare after you leave. For more information see section 6 of the Evidence of Coverage.

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

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

Download PDF 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.

AmeriHealth Advantage is available in Pennsylvania and West Virginia. Learn more.