Personal Representatives

To protect the privacy of our members’ medical records and personal health information, and to be in compliance with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), AmeriHealth is not able to authorize Personal Representative requests over the phone or through amerihealthexpress.com.

How to become a Personal Representative for an AmeriHealth member^*

• Complete and submit a Personal Representative Request form by mail to:

Member Correspondence
P.O. Box 41890
Philadelphia, PA 19101-1890
Or fax to: 215-241-2042 or 888-457-3013 (toll free)

• All submissions MUST include a copy of one of the following documents (notary’s seal must be visible on photocopies):
• power of attorney
• guardianship papers
• death certificate (when requesting the medical records of a deceased member)
• AmeriHealth will send a letter acknowledging receipt of the request and verifying the personal representative’s authority to make health-related decisions on behalf of the member.

* A member may revoke the rights of his or her personal representative at any time.

Website last updated: 12/30/11
Y0041_HNS_12_301a Pending CMS Approval