Find an Elderplan Form Elderplan makes it easy to find the information you need. Please use the links below to access helpful forms. Information Update Form: English | Español Member Reimbursement Form: English | Español Member Part D Reimbursement Form: English | Español CVS Mail Service Order Form: English | Español Request for Redetermination of Medicare Prescription Drug Denial: English | Español Authorization for Release of Health Information Pursuant to HIPAA: English | Español To request a Part D Coverage Determination for Elderplan Members Only: English | Español Medicare Electronic Complaint Form: English | Español Appointing a Representative: How to Appoint a Representative Appointment of Representative: English | Español Looking for information? Find a ProviderFind a PharmacyFind a DrugFind a FormFind a Flu Shot Questions? Call Elderplan today. 1-800-353-3765 [TTY: 711] for the hearing impaired Hours of Operation: 8 a.m. to 8 p.m., 7 days a week Elderplan is availablein the 5 boroughs of NYC,Nassau, Suffolk, Westchester,Rockland, Putnam, Monroe,Dutchess and Orange counties.