Miscellaneous Forms
Access Request Form
Accounting Request Form
Advance Directives
Amendment Request Form
Privacy Notice
Restriction Request Form
Release of Information form
How to Appoint a Representative
Enrollee Rights and Responsibilities
Grievance, Appeals, and Exceptions
PrimeTime Health Plan maintains information on the number of Grievances, Appeals and Exceptions
that are made against us. This information can be obtained by writing to PrimeTime Health Plan
and mailing to P.O. Box 6029, Canton, OH 44706.
If you need more information on Grievances, Appeals, and Exceptions you may call PrimeTime
Member Services by dialing 1-800-577-5084 (toll free) or 330-363-7407 (local calls).
Our TTY phone number for the hearing impaired is toll free 1-800-617-7446.
Chapter 9 of your Evidence of Coverage explains these processes in more details.
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