Health Plans Documents
Access forms, documents, and resources for all Medicare Advantage plans.
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Health Care Proxy
Forms
EasyCare
EasyCare Plus
Total
Appointment of Representative Form
You may appoint a relative, friend, attorney, or anyone else whom you trust to act on your behalf. A representative who is appointed by the court or who is active in accordance with state law may also file an appeal or grievance for you. To appoint a representative you must complete an Appointment of Representative form.
You can give us a copy of the form or letter or mail it to:
VNS Health
Health Plans – Care Team
220 East 42nd Street
New York, NY 10017
EasyCare
EasyCare Plus
Total
Authorization for Release of Health Information Form (DOH 5032)
Your Rights and Responsibilities
Total
EasyCare Plus
EasyCare
Making Decisions About Your Health Care
Total
EasyCare Plus
EasyCare
Patient Self-Determination Policies
Prior Authorization Request Forms
EasyCare Plus
Total
EasyCare
Medicare Prior Authorization Requirements
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