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
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 available in the 5 boroughs of NYC, Nassau, Suffolk, Westchester, Rockland, Putnam, Monroe, Dutchess, Orange, Ontario, Orleans, Seneca, and Yates counties.
