If you would like to print the forms and documents yourself, please use the attachments below. Please complete the forms and address them to the appropriate individual. If mailing to Senior Care Plus, please address the form to: Senior Care Plus, 10315 Professional Circle Reno, NV 89521.
We encourage you to contact Senior Care Plus if you have any questions or concerns regarding your health care benefits. We can assist you with benefit questions, service issues, and problem resolution, as well as any form requests.
For members with an OTC benefit. Request a Provider and Pharmacy Directory For members who would like a Provider/Pharmacy Directory mailed to their home. Please have your member number ready.
2019 Premium Pay Change Form If an existing member would like to change his or her premium payment option to direct self pay (using coupon slips), electronic funds transfer (EFT) or Social Security check withholding, the member would complete the form, with the effective date, and submit it to Senior Care Plus.
HIPAA – Written and Verbal Authorization Form If an existing member would like to authorize Hometown Health / Senior Care Plus to use and/or disclose the member’s health and medical information to a personal representative the member should complete this form and submit it to Hometown Health / Senior Care Plus.
Appointment of Representative Form If an existing member would like to authorize Senior Care Plus to use and/or disclose the member’s health and medical information to a personal representative, the member would complete the form and submit it to Senior Care Plus. Following this link will take you out of the www.SeniorCarePlus.com website.
Appointment of Representative Form – Spanish If an existing member would like to appoint a representative to make any request or obtain appeals information, the member would complete the form and submit it to Senior Care Plus.
Residence Verification If the Centers for Medicare & Medicaid Services or Senior Care Plus need to verify your permanent place of residence, the member would complete the form and submit it to Senior Care Plus.
Multi-Language Interpreter Services The Multi-Language Insert is a document that contains information translated into multiple languages: (e.g., Spanish, Chinese, Tagalog, French, Vietnamese, German, Korean, Russian, Arabic, Italian, Portuguese, French Creole, Polish, Hindi, and Japanese).
Senior Care Plus A Medicare Advantage organization from Hometown Health
