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Member Materials and Forms

On this page, you can find important documents related to your Senior Whole Health of New York health plan. Click the links below to download each document.    

2021 Materials

Senior Whole Health of New York Member Handbook (English)
Senior Whole Health of New York Member Handbook (Spanish)
Provider Directory (English)
Provider Directory (Spanish)

General Information

Notice of Privacy Practices (English)
Notice of Privacy Practices (Spanish) 
Disenrollment Rights (English)
Disenrollment Rights (Spanish)
2021 Dental Services Providers (Coming Soon)

Member Forms

Appointment of Representative Form
Authorization to Release Personal Health Information (English)
Authorization to Release Personal Health Information (Spanish)
Health Care Proxy

Molina Healthcare Acquisition Frequently Asked Questions (FAQs)

Molina Healthcare Acquisition FAQs (Coming Soon)