*Paper copies of information posted on our web site
are available upon request.
**
An appointed representative is a relative, friend, advocate, doctor or other person authorized to act on your behalf in obtaining a grievance, coverage determination or appeal.If you would like to appoint a representative please reference the CMS Appointment of Representation form (Form CMS-1696). You and your appointed representative must complete this form and mail it to Molina options plus at Molina Medicare 7050 Union Park Center, Suite 200 Midvale, UT 84047
Molina Medicare is an organization with a
Medicare contract. This contract is renewed annually,
and coverage beyond the end of the contract year is not
guaranteed.
