How to Appoint a Representative?
A representative is someone that a member designates on an Appointment of Representative form, or a legal representative that has been appointed by a court or under state law.
You can name another person to act as your representative to file a
To appoint someone as your representative, you may use the Appointment of Representative Form below. You and your representative will both need to complete, sign, and date the form before sending it to CarePlus.
You will not need to complete an Appointment of Representative Form if you provide an equivalent written notice or other legal representation document with your request. A representative who is appointed by the court or who is acting in accordance with state law can file a request for you after sending us the proper legal documentation.
Appointment of Representative Form
If you would like to appoint a representative, download and complete this form before providing it to CarePlus.
Appointment of Representative Form:
You may also get the Appointment of Representative Form from the
Instructions When Appointing a Representative
The instructions below provide additional guidance on how you can appoint a representative:
How to Appoint a Representative :
Sharing your Health Plan Information
If you or your representative need CarePlus to discuss private health information (PHI) with another person or organization, please complete a Consent for Release of PHI Form. The Consent to Release of PHI form does not provide the representative with authority to make changes or submit requests on the member's behalf
