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.
AmeriHealth Advantage

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

Your Rights and Responsibilities
Your Rights and Responsibilities as a member.
AmeriHealth Advantage

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

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

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

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

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.