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Ambetter Handbooks & Forms | Ambetter from Arizona Complete Health
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!
Quick Reference Guide (QRG)
- 2023 Quick Reference Guide (QRG) (PDF)
- 2023 Quick Reference Guide (QRG) Select (PDF)
- 2022 Quick Reference Guide (QRG) Essential, Balanced & Secure Care (PDF)
- 2022 Quick Reference Guide (QRG) Off-Exchange (PDF)
Reference Materials
- Get Your Flu Shot
- Doctor's Office Visit Checklist (PDF) - Use this checklist to get prepared for your next doctor's appointment.
- Statement of Non-Discrimination
- Balance Billing Disclosures
- 2023 Transparency Notice
- 2022 Transparency Notice
- Preventive Services Guide (PDF)
- Where to go for Care
- Women's Health and Cancer Rights Act Annual Notice
- Member Appeals
- Balance Billing
- Ambetter In-Network Hemophilia Pharmacies
- Interoperability and Patient Access
- COVID-19 Home Testing Kits
- Cost Comparison Tool
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)
- Continuity of Care Assistance Form - English (PDF)
- Continuity of Care Assistance Form - Spanish (PDF)
- Coordination of Care Form (PDF)
- Prescription Claim Reimbursement Form (PDF)
- Grievance and Appeals Form (PDF)
- Appointment of Representative Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)
- Authorization Representative Designation Form (PDF)