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Handbooks & Forms for Members | Ambetter of North Carolina
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)
- 2022 Quick Reference Guide (QRG) Essential, Balanced & Secure Care (PDF)
- 2021 Ambetter Member Handbook (PDF)
- 2020 Ambetter Member Handbook (PDF)
Reference Materials
- Get Your Flu Shot
- Dr. Office Visit Checklist (PDF)
- Balance Billing Disclosures
- 2022 Transparency Notice
- 2021 Transparency Notice
- 2020 Transparency Notice
- Statement of Non-Discrimination
- Preventive Services Guide (PDF)
- 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)
- Revocation of Authorization Form (PDF)
- Grievance & Appeals Form (PDF)
- Member Reimbursement Medical Claim Form (PDF)
- Member Reimbursement Form - OTC Covid Test (PDF)
- Prescription Claim Reimbursement Form (PDF)
- Donor Transplant Travel Reimbursement Form (PDF)
- Recipient Transplant Travel Reimbursement Form (PDF)
- Member Transplant Travel Reimbursement Policy (PDF)