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Handbooks & Forms | Ambetter from Meridian
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)
- 2022 Quick Reference Guide (QRG) Essential, Balanced & Secure Care (PDF)
- 2022 Quick Reference Guide (QRG) Off-Exchange (PDF)
- 2022 Quick Reference Guide (QRG) Virtual (PDF)
Reference Materials
- Balance Billing Disclosures
- 2023 Transparency Notice
- 2022 Transparency Notice
- Women's Health and Cancer Rights Act Annual Notice
- Ambetter In-Network Hemophilia Pharmacies
- Statement of Non-Discrimination
- Prescription Claim Reimbursement Form (PDF)
- Dr. Office Visit Checklist (PDF)
- Interoperability and Patient Access
- Preventive Services Guide (PDF)
- COVID-19 Home Testing Kits
- Cost Comparison Tool
- Wellness and Health Information
Forms
- Grievance & Appeals Form (PDF)
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization to Disclose Health Information Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Member Reimbursement Medical Claim Form (PDF)
- Member Reimbursement Form - OTC Covid Test (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Nonopioid Directive Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)