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Important Documents

As a KelseyCare Advantage member, you have numerous tools and resources available to you.
 
  Appeals and GrievancesAppeals and Grievances Appointment of Representative FormAppointment of Representative Coordination of
Benefits Form
Coordination of Benefits
Order New or
Replacement ID Card
Order New ID Card
Rights and Responsibilities 


 Privacy Policy
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Ask an Expert


Compliance & Fraud

​​About Medicare's Best Available Evidence Policy

Organization Determination and Payment Request

Appointment of Representative Form

If you need someone to file a grievance, coverage determination or appeal on your behalf, you can name a relative, friend, advocate, doctor or anyone else as your appointed representative. If you want someone to act for you, then you and that person must sign and date a statement that gives the person legal permission to act as your appointed representative.

To download a copy of Medicare's Appointment of Representative form, click here.

If you want to appoint a representative, you should complete the Appointment of Representative form on the Medicare.gov website and mail it to:

KelseyCare Advantage
ATTN: Member Services
P.O. Box 841569
Pearland, Tx 77584

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Coordination of Benefits Form
After you enroll, if you have more than one medical plan, you can complete the Coordination of Benefits form.  Having more than one medical plan may save on medical costs by coordinating your benefits.  The information you provide will help us determine if your other medical plan is primary or secondary to your KelseyCare Advantage plan.  Go to the Coordination of Benefits Form.

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Order New or Replacement ID Card
Your ID card shows information important to your health insurance coverage. You don’t need a new ID card every year. If you change plans, we will send you a new ID card.

For a new or replacement ID card, you may request one here or contact a KelseyCare Advantage Member Services representative at one of the phone numbers below and a new ID card will be sent to the address on file for you.

(713)-442-CARE (2273) or toll free: (877)-853-9075
(TTY/TDD 1-866-302-9336)
8 a.m. to 5 p.m., Monday through Friday

Press 2 if you are a current member of KelseyCare Advantage

Press 1 if you have a question regarding your medical benefits

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Ask an Expert
For more information about your KelseyCare Advantage benefits, contact us at:

(713)-442-CARE (2273) or toll free: (877)-853-9075
(TTY/TDD 1-866-302-9336)
8 a.m. to 5 p.m., Monday through Friday
 
Or, you may request a phone call to request a phone call from a KelseyCare Advantage member service representative.
 
You may also contact Medicare at 1-800-MEDICARE 1-800-633-4277 (TTY/TDD 1-877-486-2048), 24 hours a day, seven days a week.
 
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