TotalCare (HMO D-SNP) Online Self-Service

Use this form to give permission to have a local representative contact you about the TotalCare plan.

If your TotalCare Member ID Card is damaged, lost, or stolen, you can request a new one. Fill out the online order form to request a replacement card.

Fill out the Choose or Change Primary Care Provider Form to choose your primary provider. The change will take effect on the first day of the next month.

Update the information we have on file for you, like your address or phone number. Fill out the online form to update your information.

Choose someone to be your personal representative. This person will be able to speak with TotalCare about your health care needs. Both you and the person you choose to represent you will need to sign the Appointment of Representative Form.

If you paid for a health care service that is covered by the TotalCare plan, you can ask the plan to pay you back. Fill out the Member Reimbursement Claim Form.

If you want the Alliance to share your health information with someone you choose, fill out this Information Release Form. You can tell us what information we can share and how long we share it.

You can request that the Alliance not share your health information electronically with your health care providers. Find the forms you need on our Privacy Request page.

To get a printed copy of the TotalCare Evidence of Coverage (also known as the Member Handbook), you can request that we mail you one. There is no cost to you for this service.

An HRA is a tool that helps your doctor learn about your health conditions and how your daily habits affect your health. You will get a call from us asking you to complete the assessment if one was not completed when you enrolled. This information helps your doctor understand how you are feeling—both body and mind—and find ways to help you stay healthy.

An HRA also helps you:

• Learn more about preventive care.
• Make healthy lifestyle choices.
• Manage your chronic conditions.
• Take charge of your health and wellness.

You can complete your HRA in any of these ways:

1. Online: Beginning Jan. 1, 2026, you can log into the Member Portal, go to the “Assessments” section, and select “Health Risk Assessment.”
2. By Phone: Call your Care Team at 800-700-3874, ext. 5512 (TTY: 711), Monday through Friday, 8: a.m. to 5 p.m. Someone can help you fill it out and answer your questions.