Health Plans Documents

Access forms, documents, and resources for all Medicare Advantage plans.

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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

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EasyCare EasyCare Plus Total
Authorization for Release of Health Information Form (DOH 5032)
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Total
CDPAS Recertification – Physician Order Form

Total Members can have their home care service provided by a consumer directed personal care assistant through Consumer Directed Personal Assistance Services (CDPAS). The physician order form is required during the initial assessment and every 6 months during CDPAS recertification.

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Physician Order Form
EasyCare Plus Total EasyCare
Health Information Exchange Fact Sheet and Form
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Prior Authorization Request Forms
EasyCare EasyCare Plus Total
Medicare Prior Authorization Requirements
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Medicare Prior Authorization Requirements
EasyCare Plus Total EasyCare
New York State Medicaid Prior Authorization Request Form for Prescriptions
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NYS Medicaid Prior Authorization Request Form
Total
Pre-Authorization Request Form for VNS Health Managed Long Term Care Plans
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Pre-Authorization Request Form
Total EasyCare Plus EasyCare
Request for Medicare Prescription Drug Coverage Determination – Online Form
Total EasyCare Plus EasyCare
Request for Medicare Prescription Drug Coverage Determination – PDF Form
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Determination Form
Total EasyCare Plus EasyCare
Request for Medicare Prescription Drug Coverage Redetermination
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Redetermination Form