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VNSNY CHOICE MLTC Member Materials & Forms

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

Help Us Help You Better!

We’re committed to being the best CHOICE for you. That’s why we wanted to let you know that you may be asked to complete a Member Satisfaction Survey by mail. The survey is anonymous and will not impact your benefit in any way. It is being conducted by Island Peer Review Organization (IPRO), on behalf of the New York State Department of Health.

We value your feedback and thank you in advance for completing the survey, and for being a member of VNSNY CHOICE MLTC. If you have any questions, please call your Care Team.

Plan Information

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

Member Handbook Insert: Important Change for Arranging and Using Your Transportation Benefit

Provider Information

Online Provider Search Tool

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

Provider Directory (PDF)

If you need a directory in a printable format see the PDF’s below.

Forms and Personal Health Materials

CDPAS Recertification – Physician Order Form

CHOICE 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 six months during CDPAS recertification.

Last updated: 3/5/2020.

Download: Form

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

Includes information on Member Bill of Rights and Responsibilities, Patient Self-Determination Policies, Making Decisions About Your Medical Care Planning in Advance For Your Medical Treatment

Notice of Privacy Practices

Notice of Non-Discrimination Practices

Member Newsletters

VNSNY CHOICE MLTC Member Newsletters

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