Elderplan makes it easy to find the information you need.
Please use the links below to access helpful forms.
Member Information Update Form
Prescription Reimbursement Claim Form
Prescription Drug Mail Order Form
Redetermination of Prescription Drug Denial Form
Authorization for Release of Health Information
Request for Part D (Prescription Drug) Coverage
Medicare Electronic Complaint Form
Appointing a Representative:
Contact Member Services
If you are an Elderplan Member and have questions or concerns, please don’t hesitate to contact Elderplan Member Services at 1-800-353-3765 [TTY: 711], 8 a.m. to 8 p.m., seven days a week.
For additional information on how to get in touch with us, visit our Member Services Page.
Want to become an Elderplan member?
Call our Enrollment Call Center at
1-866-360-1934 [TTY: 711]
8 a.m. to 8 p.m., 7 days a week or enroll online.