Member Plan Documents & Forms

Find tools, information, and other resources to help you get the most out of your benefits with Align Senior Care

Name an Appointed Representative

You or someone you name may file a complaint (grievance) or appeal for you. The person you name would be your “appointed representative”. You may name a relative, friend, lawyer, advocate, health care provider, or anyone else to act on your behalf.

To appoint a representative, fill out CMS Appointment of Representative Form (CMS Form-1696).

Print and mail the form to:

Align Senior Care
Appeals and Grievances Department
PO Box 4440
Glen Allen, VA 23058

You may also send a fax to 1-833-610-2380

For a description of, and information on how to appoint a representative, you may also call Member Services at: