Member materials and forms

Here, you’ll find the info and forms you need to get the most from your plan.

Member materials

Mountain Health Trust - Medicaid and CHIP (PDF)

Aetna Better Health of West Virginia Community Report (PDF)

A copy of the Aetna Better Health of West Virginia Annual Report is also available to you. If you'd like to receive a copy, call Member Services at 1-888-348-2922 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.

Forms

Authorization to release protected health information (PHI) (PDF)

Authorization to release psychotherapy notes (PDF)

Protected health information access request (PDF)

Fraud, waste and abuse form

Member Advisory Committee (MAC) form

Freedom of Choice form (PDF)

FamilyCare Central ROI Form (PDF)

What's covered?

Apply or renew

For members

Health and wellness

Member materials and forms