Forms & Resources

Use these resources to better manage your plan. We now offer form submission via DocuSign on many items, to help you save time and streamline the submission process. If you have questions or need additional guidance or information, contact your agent.

General Resources

Appeal Request Form

Use this form to submit an appeal on a claim. Make sure you have you have a copy of the claim or the Explanation of Benefits (EOB) to include with your submission.

Request for Appointment of Personal Representative Form

Plan Members must complete this information to release PHI to a provider or other party.

SafeGuard Preventative Services

Questions? Contact Us.

We’re here to answer your questions or get your the information you need. Contact us using the customer service number found on your ID card.

Learn more about the plans Ascension Personalized Care (APC) offers. APC is Individual ACA Marketplace coverage.
To find your general agent, click here: