Member Forms

Below you will find links to various forms and other documents that members of VNSNY CHOICE may sometimes have a need for.

Of course, you may call Member Services if you need additional information or support:
(TTY: 711)
Monday – Friday, 8 am – 8 pm
Medicare Advantage Forms
Release Health Info Forms (English, Spanish)
Request for Medicare Prescription Drug Coverage Determination Form (English)
Request for Medicare Prescription Drug Coverage Redetermination Form (English)
Grievance and Appeals Complaint Form (English, Spanish)

Appointment of Representitive Form (EnglishSpanish)
This is a Medicare-related page; some of the links will take you to non-Medicare information or to a different website.
Last updated 2/15/2017

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