Handbooks and forms

Your member handbook

Get familiar with your handbook for an overview of your 65Plus Platinum policy. The handbook does not provide full details of your plan benefits. Please refer to your 65Plus Platinum Policy for more details about your covered benefits, exclusions and limitations. View or download your 65Plus Platinum Member Handbook now.

65Plus Bank Funds Authorization form

Save yourself the trouble of mailing checks for your 65Plus Platinum premium payments. Complete the Bank Authorization to Withdraw Funds form to have payments automatically deducted from either your checking or savings account.

*Please note, for checking accounts, attach a voided check.  For savings accounts, please attach a letter from your bank including the routing number and savings account number.

Monthly automatic bank withdrawals are made on the 5th of the month. Download and print the Bank Authorization to Withdraw Funds form and mail to Health Tradition Health Plan.

Consent forms

To have someone act on your behalf to inquire about claims or referrals, resolve issues for you, make changes to your account or file a complaint, you must send Health Tradition a signed document that authorizes that person as your representative. You must indicate the information that can be discussed with the representative as well as those that cannot. You can also limit the types of information and the time frames for the authorization. Print, complete, and mail the form to Health Tradition Health Plan. Authorization for Disclosure of Information

You have the right to revoke an Authorization for Disclosure of Information at any time. Print, complete, and mail this form to Health Tradition Health Plan: Print, complete and mail the form to Health Tradition Health Plan.  Revocation of Authorization for Disclosure of Information

Complaint and Grievance forms

If you have questions or complaints about any aspect of Health Tradition 65Plus Platinum you may try and resolve the problem on an informal basis.  Members may try and resolve the problem by directly contacting our Customer Service team at 877-823-1823 (toll-free) for assistance.

If the complaint cannot be resolved informally, you or an authorized representative have a right to appeal the Plan’s decision by filing a formal written Grievance.  You or your authorized representative may submit a Grievance along with copies of any supporting documents to Health Tradition Health Plan.

65Plus Cancellation Request form

A member may terminate their 65Plus Platinum coverage by sending a written request to Health Tradition Health Plan.  Health Tradition will not accept verbal requests to cancel coverage.

Enrollment into another Medicare Supplement or Medicare Advantage plan does not automatically cancel your coverage with 65Plus Platinum.

Print, complete and mail the form to Health Tradition Health Plan.  65Plus Cancellation of Coverage

How to locate the forms you need

Review these lists, download and print the appropriate form. If you are not sure of which form to complete, contact Customer Services at 877-832-1823 for assistance.

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