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Handbooks & Forms for Ambetter Members | Ambetter from Absolute Total Care
Member Resources
Many of our member resources, such as the member handbook and forms, can be found by logging into your online member account. Click Login to create an account and access a wide array of resources!
Ambetter Takes Our Commitment To You Seriously, And Is Honored To Keep You Covered During This Unprecedented Health Situation.
For more details on COVID-19, Ambetter plan coverage, Telehealth, and prescription refills, please visit our FAQs page.
2022 Evidence of Coverage (EOCs)
Quick Reference Guide (QRG)
- 2022 Quick Reference Guide (QRG) Essential, Balanced & Secure Care (PDF)
- 2022 Quick Reference Guide (QRG) Virtual (PDF)
Reference Materials
- Get Your Flu Shot
- Balance Billing Disclosures
- 2022 Transparency Notice
- 2021 Transparency Notice
- 2020 Transparency Notice
- Statement of Non-Discrimination
- Preventive Services Guide (PDF)
- Quality Improvement (QI) Program
- Preventive Guidelines
- Where to Go for Care
- Office Visit Checklist (PDF)
- Women's Health and Cancer Rights Act Annual Notice
- Ambetter In-Network Hemophilia Pharmacies
- Dr. Office Visit Checklist (PDF)
- Interoperability and Patient Access
- COVID-19 Home Testing Kits
Forms
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization Form (PDF)
- Member Reimbursement Medical Claim Form (PDF)
- Member Reimbursement Form - OTC Covid Test (PDF)
- Grievance & Appeals Form (PDF)
- Prescription Claim Reimbursement Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)