TotalCare Member Forms

For TotalCare referrals to Environmental Accessibility and Adaptability services.

For TotalCare referrals for Medically Tailored Meals (MTM) and Medically Supportive Food (MSF)

This form is for TotalCare members who may qualify for no-cost Community Supports to help with housing.

TotalCare members can fill out this form if you need at-home care with daily tasks.

Request for Medicare Prescription Drug Coverage Determination

Request for Redetermination of Medicare Prescription Drug Denial

Medicare Part D Prescription Drugs Claim Form

TotalCare members can fill out this form to report potential compliance and fraud, waste and abuse concerns.

TotalCare HMO D-SNP 담당자를 예약하는 방법을 알아보세요.

이 양식에 서명함으로써 귀하는 Central California Alliance for Health에 귀하의 보호된 건강 정보를 아래에 설명된 특정 목적을 위해 사용하거나 공개하는 데 대한 권한을 부여합니다.

Choose or change your TotalCare (HMO D-SNP) primary care provider

TotalCare(HMO D-SNP)에 가입하고자 하는 Medicare 가입자를 위한 해지 양식입니다.

Enrollment form for people with Medicare who want to join TotalCare (HMO D-SNP).

Skip to content Find a Doctor Nurse Line Provider Portal Contact Us aA Accessibility ToolsGrayscaleAAA Search Search Health Plans Medi-CalMedi-Cal is California’s Medicaid health care program that provides no-cost or low-cost health insurance to Californians. Alliance TotalCare (HMO D-SNP)The Alliance’s TotalCare HMO D-SNP is a special type of Medicare Advantage plan that is available to…

TotalCare HMO D-SNP에 대한 정보를 공개하는 방법을 알아보세요.

귀하의 건강 정보 사본을 원하거나 귀하의 정보가 다른 조직과 공유되는 방식을 제한하려는 경우 개인 정보 보호 요청을 할 수 있습니다.

Learn how to replace your TotalCare (HMO D-SNP) member ID card

Use this form to ask TotalCare to send your confidential or sensitive health information to a different address, phone number, or email.

The TotalCare will acknowledge receipt of your complaint or appeal in writing within five (5) calendar days, and respond to your complaint or appeal in writing within thirty (30) calendar days.

TotalCare members can use this form to sign up for health programs. Please allow 10 business days for us to process your request.

Fill out the TotalCare Member Reimbursement Claim Form to ask for reimbursement for covered services. If you have any questions or need assistance with this form, please call our Member Services department at 833-530-9015.

Please fill out the Records Access Request Form to obtain a copy of your TotalCare medical records.

If you have changes to your address or phone number, you will need to contact both TotalCare and your county’s Medi-Cal office to update your contact information. Fill out this form to update your address and/or phone number with TotalCare.