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Handbooks & Forms for Members | Ambetter from Arkansas Health & Wellness
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!
Ambetter Takes Our Commitment To You Seriously, And Is Honored To Keep You Covered During This Unprecedented Health Situation.
For more details on COVID-19, Ambetter plan coverage, Telehealth, and prescription refills, please visit our FAQs page.
Quick Reference Guide (QRG)
- 2022 Quick Reference Guide (QRG) ARFFM (PDF)
- 2022 Quick Reference Guide (QRG)ARPO (PDF)
- 2021 Member Handbook for Members in the Heatlh Insurance Marketplace (PDF)
- 2021 Member Handbook for Arkansas Works Members (PDF)
Reference Materials
- Auto Bill Pay Terms and Conditions (PDF)
- Dr. Office Visit Checklist (PDF)
- Get Your Flu Shot
- Health Sheets Education Resource
- Preventive Services Guide (PDF)
- Primary Care Physician Visit Checklist (PDF)
- Quality Improvement (QI) Program
- Statement of Non-Discrimination
- Balance Billing Disclosures
- 2022 Transparency Notice
- 2021 Transparency Notice
- 2020 Transparency Notice
- Where To Go For Care
- Women's Health and Cancer Rights Act Annual Notice
- Ambetter In-Network Hemophilia Pharmacies
- Interoperability and Patient Access
- COVID-19 Home Testing Kits
Forms
- Authorization to Disclose Health Information Form (PDF)
- Grievance, Appeal, Concern or Recommendation Form (PDF)
- Member Reimbursement Medical Claim Form (PDF)
- Member Reimbursement Form - OTC Covid Test (PDF)
- Dental Member Reimbursement Form (PDF)
- Prescription Claim Reimbursement Form (PDF)
- Revocation of Authorization to Disclose Health Information (PDF)
- Donor Travel Reimbursement Form (PDF)
- Recipient Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)
- Authorization Representative Designation Form (PDF)
Educational Materials
- Mental Health Follow-Up (PDF)
- Antidepressants Adherence (PDF)
- Colorectal Cancer (PDF)
- Admitted to the Hospital (PDF)
- Coping with Anxiety (PDF)
- How Buprenorphine Can Help with Pain and Opioid Addiction (PDF)
- Getting Help for Opioid Use Disorder and Opioid Addiction (PDF)
- What to Do During an Opioid Overdose (PDF)
- How to Keep You and Your Loved Ones Safe when Using Pain Medication (PDF)
- My Wellness Checklist (PDF)
- Long-Acting Medicines (PDF)