Who may ask for a grievance or an appeal?

You or someone you name to act for you (your appointed representative) may request a grievance or an appeal. You can name a relative, friend, advocate, attorney, doctor, or someone else to act for you. Others may already be authorized under state law to act for you. Please fill out the Appointment of Representative form and send it to us with your request. You can call us at: You can call us at: 1-888-260-1010, 7 days a week, 8am – 8pm, or TTY/TDD members call 1-888-542-3821 if you need help filling out the form or want to learn more about appointing a representative. For further information, please refer to Chapter 9 of your Evidence of Coverage with links provided below.

> Appointment of Representative form (English / Español中文)

The Appointment of Representative form is also available by visiting the CMS website.
* Please note that clicking on this link will take you away from the Healthfirst website.

 

Evidence of Coverage

Healthfirst CompleteCare (HMO SNP)

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Healthfirst Life Improvement Plan (HMO SNP)

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Healthfirst Maximum Plan (HMO SNP)

     English  Español  中文 

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Healthfirst Increased Benefits Plan (HMO)

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Healthfirst 65 Plus Plan (HMO)

     English  Español  中文 

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Healthfirst Jade Benefits Plan (HMO)

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Healthfirst AssuredCare (HMO SNP)

     English  Español  中文 

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