Below you will find links to various forms and other documents that members of VNSNY CHOICE Total may sometimes have a need for.
Of course, you can also call Member Services if you need additional information or support:
(TTY users call 711)
Monday – Friday, 8 am – 8 pm
Request for Medicare Prescription Drug Coverage Determination Form (English)
Appointment of Representative Form (English, Spanish)
VNSNY CHOICE Medicare Total is an HMO SNP plan with a Medicare contract. This plan is also a Medicaid Advantage Plus plan, with a contract with the New York State Department of Health. Enrollment in VNSNY CHOICE Medicare depends on contract renewal.