Member Forms & Resources

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Reimbursement Forms

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For members in Ohio seeking flu vaccination reimbursement. Contact Customer Service with specific benefit questions.
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For members in Pennsylvania seeking flu vaccination reimbursement. Contact Customer Service with specific benefit questions.
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HealthAmerica and Advantra Case Management Request Form


Additional Member Information

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Advance Directives ("Living Wills") for Health Care in Pennsylvania
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Advance Directives ("Living Wills") for Health Care in Ohio
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The Diabetes Physician Recognition Program (DPRP) recognizes physicians for demonstrated high quality care patients with diabetes.  Note: not all DPRP physicians participate in the HealthAmerica and HealthAssurance network.
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How We Evaluate New Medical Technology
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Filing a Complaint or Appeal
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Finding a Network Health Care Professional and Information about Them - Ohio
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Finding a Network Health Care Professional and Information about Them - Pennsylvania
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Information about Our Chronic Disease Management Programs
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To promote safe practices, HealthAmerica encourages our network hospitals to respond to the national Leapfrog hospital safety survey. The Leapfrog Group works with medical experts nationwide to identify problems and propose solutions to improve hospital safety.
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Member Rights and Responsibilities
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Notice of Privacy Practices (English)
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Notice of Privacy Practices (Spanish)
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Obtaining Care When Outside the Service Area
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Obtaining Emergency Care
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PA Health Care Cost Containment Council
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Precertification Requirements
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Quality and Compliance - Provider Credentialing
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Quality and Compliance - What Our Quality Improvement Program Does for You
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Quality and Compliance - Quality Improvement Newsletter
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Quality and Compliance - Health Care Law and Legislation
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Receiving Primary Care
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Standards Our Network Providers Must Meet
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Submitting a Claim for Covered Services
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What Utilization Management Is and How Decisions Are Made
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Page Last Updated: 05/11/2009
CMS Approved Date: Pending CMS Approval
CMS Document ID: M0003C0002_09MAPDPDP_502_CVTYWEBs508a

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