An enrollee may have a representative who is either appointed by the enrollee or authorized under State or other applicable law to act on behalf of the enrollee in filing a grievance, requesting a coverage determination, or in dealing with any level of the appeals process.
An enrollee may appoint any individual (such as a relative, friend, advocate, attorney, physician or other prescriber, or an employee of a pharmacy, charity, state pharmaceutical assistance program, or other secondary payer) to act as his or her representative. Alternatively, an enrollee's representative (surrogate) may be appointed by a court or authorized under State or other applicable law to act on the enrollee's behalf. A surrogate could include, but is not limited to, a court-appointed guardian, an individual who has Durable Power of Attorney or a healthcare proxy, or a person designated under a healthcare consent statute.
If an enrollee wishes to appoint a representative to act on his or her behalf, the enrollee must submit a written representative statement to the Part D plan sponsor. An enrollee may use the "Appointment of Representative" form (provided on the same webpage where you accessed this link) or an equivalent written notice to make the appointment. A notice is an "equivalent written notice" if it: