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Plan Materials

MLTC Member Materials and Forms

The list below includes links to a variety of materials for VNS Health MLTC members. You can get a printed copy of any member materials by calling 1-888-867-6555 (TTY: 711), Monday–Friday, 9 am–5 pm.

Plan Information

Member Handbook

Last updated: 11/06/2020

Member Handbook Insert
New York Independent Assessor – Initial Assessment Process

Last updated: 03/24/2021

Member Handbook Insert
MLTC Will Remove Service Limits for PT, OT, and ST

Last updated: 01/29/2021
Provider Information

Online Provider Search Tool

Find an up-to-date list of in-network providers in your community. The search results are printable.

Provider Directory

If you need a directory in a printable format, see the PDF files below.
Forms and Personal Health Materials

CDPAS Recertification – Physician Order Form

MLTC 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.
Download PDF: Form

Health Care Proxy

Authorization for Release of Health Information Form (DOH 5032)

Health Information Exchange Fact Sheet

Authorization for Access to Patient/Member Information Through a Health Information Exchange Organization

Member Rights and Responsibilities Booklet

This booklet includes information on Member Bill of Rights and Responsibilities, Patient Self-Determination Policies, Making Decisions About Your Medical Care, and Planning in Advance for Your Medical Treatment.

Notice of Privacy Practices

Notice of Non-Discrimination Practices

Member Newsletters

MLTC Member Newsletters

See current and past issues of Member Newsletter for health tips and checklists, recipes, and more.