VNSNY CHOICE Total Forms and Personal Health Materials
Looking for more in-depth information about your VNSNY CHOICE Total (HMO D-SNP) health plan and membership? You’ll find it here, along with forms and other tools and materials to help you make the most of your membership.
If you can’t print them yourself, you can get a printed copy of anything on this page by calling Member Services at 1-888-783-1444, 8 am – 8 pm, 7 days a week. TTY users should call 711.
Appointment of Representative Form
You may appoint a relative, friend, attorney, or anyone else whom you trust to act on your behalf. A representative who is appointed by the court or who is active in accordance with State law may also file an appeal or grievance for you. To appoint a representative you must complete an Appointment of Representative Form.
You can give us a copy of the form or letter or mail it to: VNSNY CHOICE Total 220 East 42nd Street, 3rd floor, New York, NY 10017