Member Materials
Here are links to the manuals, forms, and policies available to you. Any documents and items offered in electronic format can be requested in paper format. To request a document in paper format, please contact Member Services at 1-833-552-3876 (TTY 711).
Once you have completed your request, the paper format item(s) will be mailed within 5 business days from the date of the request.
Member Forms
- Designation of Authorized Representative Form (PDF)
- Authorization to Use and Disclose Health Information (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information (PDF)
- Request for Amendment of Health Information (PDF)
- Request for Accounting of Disclosures of Health Information (PDF)
- Request for Restrictions on Use and Disclosure of Health Information (PDF)
- Request for Accessing/Inspecting/Copying Health Information (PDF)
- Member Complaint (Grievance) Form (PDF) - English
- Member Complaint (Grievance) Form (PDF) - Spanish
- Member Compliment and Feedback Form (PDF) - English
- Member Compliment and Feedback Form (PDF) - Spanish
Member Resources
- Health Plan Information Booklet and Forms
- Diabetic Living Toolkit – A Guide to Managing Your Diabetes (PDF) – English
- Telemedicine Informational Flyer (PDF) - English/Spanish
- ModivCare Mileage Reimbursement Form and Instructions (English)
- ModivCare Mileage Reimbursement Form and Instructions (Spanish)
- Notice of Nondiscrimation and Taglines (PDF) - English/Spanish
Privacy Practices
Auxiliary Aids, Large Print, and Interpreter Services
If English is not your first language, we can help. Call Carolina Complete Health Member Services at 1-833-552-3876 (TTY 711).
You can request free auxiliary aids and services, including any material offered electronically and other information in large print. To request an aid or service, please call Carolina Complete Health Member Services at 1-833-552-3876 (TTY 711).
We can give you, free of charge, any electronic materials translated in your language orally or in writing, access to interpreter services, and can help answer your questions in your language. For help, please call Carolina Complete Health Member Services at 1-833-552-3876 (TTY 711).
Let Your Voice Be Heard and Earn Up to $300!*
Join the Member Advisory Committee and earn $75 for each meeting you attend! You will meet with other members four times a year and provide feedback on how Carolina Complete Health can improve your health plan.
*Carolina Complete Health Member Advisory Committee members can receive up to $300 stipend every 12 months or $75 for each consecutive meeting they attend. Limit four gift cards per member.