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Quick Reference Guide & Forms for Members | Ambetter from Nebraska Total Care
Member Resources
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!
Quick Reference Guide (QRG)
- 2023 Quick Reference Guide (QRG) (PDF)
- 2022 Quick Reference Guide (QRG) Essential, Balanced & Secure Care (PDF)
Reference Materials
- Balance Billing Disclosures
- 2023 Transparency Notice
- 2022 Transparency Notice
- Women's Health and Cancer Rights Act Annual Notice
- Statement of Non-Discrimination
- COVID-19 Home Testing Kits
- Preventive Services Guide (PDF)
- Cost Comparison Tool
Forms
- Grievance and Appeals Forms (PDF)
- Member Reimbursement Medical Claim Form (PDF)
- Member Reimbursement Form - OTC Covid Test (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)
- Authorization to Disclose Health Information Form (PDF)
- Revocation of Authorization Form (PDF)