If you are an Elderplan FIDA Total Care (Medicare-Medicaid) participant, your plan forms are available here.
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
Request for Redetermination of Medicare Prescription Drug Denial: English | Español
Authorization for Release of Health Information Pursuant to HIPAA: English | Español
Questions? Call Elderplan today.
1-866-360-1934
[TTY 711]
for the hearing impaired
Hours of Operation:
8 a.m. - 8 p.m., 7 days a week
Elderplan is available
in the 5 boroughs of NYC,
Nassau, Suffolk, Westchester,
Rockland, Putnam and Monroe counties.
