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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES Form Approved OMB no. 0938-0950 APPOINTMENT OF REPRESENTATIVE NAME OF BENEFICIARY MEDICARE NUMBER SECTION I: APPOINTMENT.

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Coventry Health Care, Inc. In May 2013, the company was acquired by Aetna for $5.7 billion.

ing to Medicare guidelines, an appointed representative is a person who can act on your behalf to request an exception, appeal or grievance.

Coventry Health Care Medicare Advantage Plan Highlights: An alternative to Original Medicare - commonly HMO or PPO. Plans May also cover extra services, like dental care or wellness programs. Many include prescription drug coverage.

Coventry Health Care Inc., often referred to as Coventry, is a national health insurance company. The diversified company is dedicated to providing affordable and high-quality health insurance solutions to its customers.

Aetna Inc. Since November 28, 2018, the company has been a subsidiary of CVS Health. Aetna Inc.

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health and Life Insurance Company and their affiliates (Aetna).

An appointed representative is a person who can act on your behalf to request an appeal or complaint. If you need someone to file a grievance, coverage determination, organization determination, or an appeal on your behalf, you can name a relative, friend, advocate, or anyone else as your appointed representative.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232