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)
7 days a week, 8 am – 8 pm
Authorization for Release of Health Information (English
Request for Medicare Prescription Drug Coverage Determination Form (English
Request for Medicare Prescription Drug Coverage Redetermination Form (English
) Appointment of Representative Form (English, Spanish)
Opioid Prior Authorization Request Form (English
VNSNY CHOICE 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 Total depends on contract renewal. This information is not a complete description of benefits. Call 1-866-783-1444 (TTY: 711) for more information.
This is a Medicare-related page; some of the links will take you to non-Medicare information or to a different website.
Last updated 1/17/2019