Member Resources

Prescription Drug Reimbursement Form

Use the Prescription Drug Reimbursement Form to file an eligible prescription drug claim reimbursement. See form for instructions.
Prescription Drug Reimbursement Form (PDF)

Member Record Request Form

Use this form to request your member record from AllWays Health Partners.
Member Record Request Form (PDF)
 

Member Reimbursement Claim Form

Use the Member Reimbursement Claim form to file an eligible medical or behavioral health claim reimbursement. See form for details and instructions.
Member Reimbursement Claim Form (PDF)
 

Bike Helmet Reimbursement Form

When you buy safety helmets for toddlers, children, and adults, AllWays Health Partners will reimburse 50% of the purchase price of one new helmet, per member, per calendar year up to a $15.00 reimbursement.
Bike Helmet Reimbursement Form (PDF)
 

Childbirth Education Reimbursement Form

Childbirth education classes, plus parenting and infant CPR classes, are available to you and your partner or support person free of charge at many primary care sites and hospitals.

Speak to the provider caring for you during your pregnancy or the facility where you plan to deliver about enrolling. If they do not offer a childbirth education program, AllWays Health Partners will reimburse you for the cost of these classes up to $130 per pregnancy. You can combine multiple classes up to the $130 limit per pregnancy. A Childbirth Education Form must be submitted to obtain the reimbursement.
Childbirth Education Reimbursement Form (PDF)
 

Breastfeeding Support Form

Breastfeeding support classes are also available free of charge at many primary care sites and hospitals. These classes are a support group for pregnant women, and they provide information about the benefits of breastfeeding, along with helpful tips, resources, and ways to manage common breastfeeding challenges.

Speak to the provider caring for you during your pregnancy or the facility where you plan to deliver about enrolling. If they do not offer a breastfeeding support program, AllWays Health Partners will reimburse you for the full cost of these classes. A Breastfeeding Support Form must be submitted to obtain the reimbursement.
Breastfeeding Support Form (PDF)
 

Personal Representative Designation Form

You have the right to choose one or more persons to act on your behalf with respect to the protected health information that pertains to you. If you would like to exercise this right, please complete and return this form to us.
English (PDF)
Spanish (PDF)
 

Continuity of Care at Cancer and Pediatric Facilities Notification Form

Members newly enrolled through a small employer group who began an active course of treatment for a serious illness prior to enrolling in an Easy Tier Hospital Network plan may be eligible to continue treatment at the lowest member cost-sharing tier (Tier 1). Click here to determine if you are eligible.

If eligible, the Continuity of Care at Cancer and Pediatric Facilities Notification Form (PDF) must be submitted prior to the start of treatment in the tiered network plan.

Weight Loss Reimbursement Form

The fastest way to submit a reimbursement request for your weight loss benefit is on the member portal, allwaysmember.org. You can also download the form below and follow the instructions to submit your reimbursement request. The weight loss benefit varies by plan. Please check allwaysmember.org for details about your plan.
Weight Loss Program Benefit Form and Instructions (PDF)
 

Fitness Benefit Reimbursement Form

Qualifying health clubs include:

Need to know if a service or treatment requires a prior authorization or referral? Check the Service Approval Guidelines (PDF).
 

The AllWays Health Partners medical policies, or clinical coverage criteria, help us evaluate the safety and effectiveness of a service or technology to determine if it should be covered.

You can browse the medical policies to see the coverage criteria for a specific condition. However, the medical policies will not tell you whether a service or technology is covered under your plan.

For more information about our medical policies or about your plan, please call the Customer Service number on the back of your member ID card or email customerservice@allwayhealth.org.

You can also log in to allwaysmember.org to find personalized information about your covered benefits.
View medical policies.
 

Here’s a list of information that can help you understand your rights and get the most from your plan. Visit allwaysmember.org for details about the information described below.
 

Member Rights and responsibilities

Your basic rights and responsibilities as an AllWays Health Partners member.
 

Benefit coverage and obtaining care

How to use your benefits and what’s covered.
 

Notice of privacy practices and confidentiality

Our policy for protecting your health information.
 

Post-mastectomy benefits

What you’re entitled to if you have a mastectomy.
 

Appeal and grievance process

How to appeal a denial or submit a formal complaint.
 

Preventive care guidelines for children

When your child should have preventive care and what’s covered.
 

Preventive care guidelines for adults

When you should have preventive care and what’s covered.
 

Changes to pharmacy benefits

Any updates to your pharmacy benefits are listed here monthly.
 

Incentives statement

AllWays Health Partners does not specifically reward providers or any organization reviewing our coverage decisions.

Utilization management

How to learn more about coverage requests, approvals, and denials.
 

Advance Directives/Health Care Proxy

How to choose a representative to speak for you in case you can’t make your own medical decisions.
Call the Customer Service number on the back of your AllWays Health Partners member ID card with any questions about these materials.

Transition of care form

Complete and submit this form to request access to ongoing care during your transition to AllWays Health Partners.