Senior couple is discussing a home budget together at home

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.
Forms & Documents
2022 Pre-Enrollment Checklist for Northern Nevada Plans (English | Spanish) Updated 01/01/22
2022 Pre-Enrollment Checklist for Northern Nevada Plans (English | Spanish) Updated 01/01/22
2022 Pre-Enrollment Checklist for Encompass Plan (English) Updated 01/01/22
2022 Enrollment Form for Northern Nevada Plans (Patriot, Essential, Select) (English) Updated 01/01/22
2022 Enrollment Form for Renown Preferred Plan (English) Updated 01/01/22
2022 Enrollment Form for Comprehensive & Encompass Plans (English) Updated 01/01/22
2022 Enrollment Form for Complete Plan (English) Updated 01/01/22
2022 Over-the-Counter Catalog (English) Updated 01/01/22
2022 Over-the-Counter Order Form (English) Updated 01/01/22
Medical Claim Form
For individuals who need to submit a medical claim.
Medicare Part B Form – English – Updated 01/01/22
For individuals who need to sign up for Medicare Part B (Medical Insurance).
Medicare Part B Form – Spanish – Updated 01/01/22
For individuals who need to sign up for Medicare Part B (Medical Insurance).
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.
Right of Access Form – Updated 12/01/21
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 – English – Updated 08/01/18
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 – Updated 08/01/18
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 – Updated 03/01/22
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.
Prior Authorization Form – Updated 01/01/22
Form used by provider to request a prior authorization.
Provider Claim and Authorization Reconsideration Form Updated 01/01/20
Form used by a provider for authorization reconsideration.
Coverage Determination Request – Updated  01/01/19
 

Senior Care Plus
A Medicare Advantage organization from Hometown Health

Material ID: H2960_2023_SCPWebsite1_M (CMS Accepted)

Last updated:  June 17 2022