- Evidence of Coverage
- Summary of Benefits
- Formulary
- Grievances & Appeals
- Provider/Pharmacy Directory
- LIS Premium Summary Chart
- Disenrollment Rights
- Appointing a Representative
- Member Handbook
- Member Handbook
Appointing a Representative
You have the right to appoint a representative (such as a relative, friend, advocate, attorney, physician, etc) to act on your behalf. Both you and the person you have named as an authorized representative will need to sign the representative form, unless your representative is a lawyer. In that case, only your signature is needed. If your prescribing doctor calls on your behalf no representative form will be required.
Please click on the link below to access the Medicare Appeals Forms.
http://www.medicare.gov/basics/forms/Default.asp *
If you would like more information about appointing a representative, or if you would like to obtain a representative form, please contact Member Services. We are open weekdays, Monday through Friday, from 8 A.M. to 8 P.M., and also on Saturdays and Sundays from October 15th to February 14th.
- 1-866-211-1777 (toll-free)
- 711 (TTY)
* Please note: By clicking on this link you will be leaving the SWH web site.
Last modified: 12/22/2011