An authorized representative is the person you choose to handle affairs related to your health care services. This may be someone you designate as a Power of Attorney, a family member, friend, caregiver, or an advocate of your choice. To become an authorized representative, you’ll need to download and print CMS Appointment of Representative Form (CMS Form1696). Both you and the person you wish to represent will need to sign the form.
Fill out the form and one of our dedicated team members will contact you.
Care is available 24 hours a day, 365 days a year.
Participants may be financially responsible for any services not authorized by Senior LIFE. In-network and out-of-network emergency services are covered by Senior LIFE. Senior LIFE is a voluntary program. Participants may disenroll at any time. All services with the exception of emergency care must be preapproved by the interdisciplinary team. All other services approved by the interdisciplinary team are provided and/or coordinated by Senior LIFE.
Senior LIFE H-Plan Identification Codes: H0819, H2937, H2992, H3925, H5902, H5978
*Spanish translation of this website is pending CMS approval*
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