HAVE AN ENROLLMENT NEED? SHOP OUR PLANS
Handbooks & Forms | Ambetter from Western Sky Community Care
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)
Reference Materials
- PCP Referrals
- Balance Billing Disclosures
- 2023 Transparency Notice
- 2022 Transparency Notice
- Women's Health and Cancer Rights Act Annual Notice
- Ambetter In-Network Hemophilia Pharmacies
- Prescription Claim Reimbursement Form (PDF)
- Interoperability and Patient Access
- Preventive Services Guide (PDF)
- COVID-19 Home Testing Kits
- Contraceptive Coverage Summary (PDF)
- Non-Prescription Contraception Drugs or Devices (PDF)
- Cost Comparison Tool
Forms
- Grievance and Appeals Forms (PDF)
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization to Disclose Health Information Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Member Reimbursement Medical Claim Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)
- Member Reimbursement Form - OTC Covid Test (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Member Over The Counter Contraceptive Reimbursement Claim Form (PDF)