Have an Enrollment need? Call us at 1-855-745-5507 (TTY/TDD 1-844-517-3431). Learn More.
Member Materials and Forms | Ambetter Insured by Celtic
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!
- Auto Bill Pay Terms and Conditions (PDF)
- Doctor's Office Visit Checklist (PDF) - Use this checklist to get prepared for your next doctor's appointment.
- Find a Provider Guide (PDF)
- Preventive Services Guide (PDF)
- Quality Improvement (QI) Program
- Referral and Authorization Information
- Statement of Non-Discrimination
- 2020 Transparency Notice
- 2019 Transparency Notice
- Women's Health and Cancer Rights Act Annual Notice
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization Form(PDF)
- Prescription Claim Reimbursement Form (PDF)
- Grievance and Appeals Form (PDF)
- Member Reimbursement Medical Claim Form (PDF) - Used to submit a paid claim for Out of Country emergency services received from an out-of-network international provider.
- Transplant Reimbursement Form (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)
- Provider Directory (PDF) - (Printable version)
If you need help finding a network provider and/or pharmacy, please call Member Services. You can also use our online searchable directory called Find a Provider to do so. If you would like a provider directory mailed to you, please call Member Services at 1-855-745-5507 (TTY/TDD 1-844-517-3431).