Health Plans Documents
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Health Care Proxy
Forms
EasyCare Plus
EasyCare
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
Total
EasyCare Plus
EasyCare
Authorization for Release of Health Information Form (DOH 5032)
Your Rights and Responsibilities
EasyCare
EasyCare Plus
Total
Making Decisions About Your Health Care
EasyCare Plus
Member Rights and Responsibilities upon Disenrollment
Total
EasyCare Plus
EasyCare
Patient Self-Determination Policies
Prior Authorization Request Forms
EasyCare
EasyCare Plus
Total
Medicare Prior Authorization Requirements
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