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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!
Announcement
Ambetter from Arizona Complete Health received information that one of our business partners was a victim of a cyber-attack. Learn more.
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.
Member Handbook
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
- 2021 Transparency Notice
- 2020 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
Forms
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization Form (PDF)
- Member Reimbursement Medical Claim Form (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)