Member Resources

Many of our member resources, such as the member handbook and forms, can be found by logging into your online member account. Click Login to create an account and access a wide array of resources!

Quick Reference Guide (QRG)

2023 Quick Reference Guide (QRG) (PDF)
2022 Quick Reference Guide (QRG) Essential, Balanced & Secure Care (PDF)
2022 Quick Reference Guide (QRG) Value (PDF)
2022 Quick Reference Guide (QRG) Off-Exchange (PDF)
2022 Quick Reference Guide (QRG) Select (PDF)

Reference Materials

Doctor's Office Visit Checklist (PDF) - Use this checklist to get prepared for your next doctor's appointment.
Get Your Flu Shot
Preventive Services Guide (PDF)
Quality Improvement (QI) Program
Referral and Authorization Information
Statement of Non-Discrimination
Balance Billing Disclosures - EPO
Balance Billing Disclosures - HMO
2023 Transparency Notice - EPO
2023 Transparency Notice - HMO
Where to go for Care
Women's Health and Cancer Rights Act Annual Notice
Ambetter In-Network Hemophila Pharmacies
Reading an Explanation of Benefits (EOB) 2.0 (effective 6/6/2021) (PDF)
Interoperability and Patient Access
Know Your Mental Health & Substance Use Disorder Benefits
Cost Comparison Tool
Wellness and Health Information
Ambetter Value Plan Information

Forms

Authorization to Disclose Health Information Form - English (PDF)
Authorization to Disclose Health Information Form - Chinese (PDF)
Authorization to Disclose Health Information Form - Vietnamese (PDF)

Revocation of Authorization Form (PDF)

Grievance and Appeals Form - English (PDF)
Grievance and Appeals Form - Chinese (PDF)
Grievance and Appeals Form - Vietnamese (PDF)

Member Reimbursement Medical Claim Form - English (PDF)
Member Reimbursement Medical Claim Form - Chinese (PDF)
Member Reimbursement Medical Claim Form - Vietnamese (PDF)

Prescription Claim Reimbursement Form - English (PDF)
Prescription Claim Reimbursement Form - Chinese (PDF)
Prescription Claim Reimbursement Form - Vietnamese (PDF)

Donor Transplant Travel Reimbursement Form - English (PDF)
Donor Transplant Travel Reimbursement Form - Chinese (PDF)
Donor Transplant Travel Reimbursement Form - Vietnamese (PDF)

Recipient Transplant Travel Reimbursement Form - English (PDF)
Recipient Transplant Travel Reimbursement Form - Chinese (PDF)
Recipient Transplant Travel Reimbursement Form - Vietnamese (PDF)

Member Transplant Travel Reimbursement Policy (PDF)

Referral Form Fraud, Waste, Abuse (PDF)

Member Materials and Forms | Ambetter from Sunshine Health

Member Resources

Quick Reference Guide (QRG)

Reference Materials

Forms

Authorization to Disclose Health Information Form

Revocation of Authorization Form

Grievance and Appeals Form

Member Reimbursement Medical Claim Form

Prescription Claim Reimbursement Form

Donor Transplant Travel Reimbursement Form

Recipient Transplant Travel Reimbursement Form

Member Transplant Travel Reimbursement Policy

Referral Form Fraud, Waste, Abuse