AvMed makes it easy to manage your account by providing forms and other tools for making requests. Simply print and fill out one of our pre-composed forms for quick, easy service. Certain requests can be submitted directly online.
AvMed Medicare Choice Enrollment Form
AvMed Medicare Choice Formulario para Inscripción
Appointment of Representative (Medicare members)
Designated Record Set (DRS) Request Form
Medicare Rx Mail Order Form
Medicare Rx Formulario para Ordenar
Medication Exception Request Form
Model CMS Drug Determination Request Forms
Medicare Complaint Form
Member Disclosure Form
Medical Direct Member Reimbursement Form
Pharmacy Direct Member Reimbursement Form
Mental Health Direct Member Reimbursement Form
Quality Assurance Drug Management Programs
Drug Utilization Review
2018 Medication Therapy Management (MTM)
Personal Medication List
2018 Part D Prior Authorization Criteria (Effective September 1, 2018)
2018 Part D Step Therapy Criteria (Effective September 1, 2018)
2017 Part D Transition Policy
AvMed Medicare is an HMO plan with a Medicare contract. Enrollment in AvMed Medicare depends on contract renewal.
Address: 9400 S. Dadeland Blvd. Miami, FL 33156
Prospective Members: 888-492-8633 (TTY 711)
Current Members: 800-782-8633 (TTY 711)
October 1–February 14, 8 am-8 pm, 7 days a week.
February 15–September 30, 8 am-8 pm, Monday-Friday; 9 am- 1pm on Saturday.
H1016_AD781-092017 CMS pending. Last updated October 1, 2017.