Forms and Documents
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.
Medical Claim Form
For individuals who need to submit a medical claim.
Medicare Part B Form
For individuals who need to submit a medical claim. Updated 01/01/22
Request a Provider & Pharmacy Directory
For members who would like a Provider/Pharmacy Directory mailed to their home. Please have your member number ready.
Right of Access 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. Updated 12/01/21
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. Updated 08/01/18
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. Updated 03/01/22
Prior Authorization Form
Form used by provider to request a prior authorization. Updated 01/01/22
Provider Claim & Authorization Reconsideration Form
Form used by a provider for authorization reconsideration. Updated 01/01/20
Coverage Determination Request