Back Appoint a Representative

In order for Solis to process a Grievance or/and Appeal request from someone other than you (the member), your physician, your prescribing physician (Part D), or other prescriber (Part D), we must have authorization from you. You may appoint any individual as your representative by sending us an Appointment of Representative form signed by both you and the representative. A representative who is appointed by the court or who is acting in accordance with state law may also file a request for you after sending us the legal representative form.

You will not need to complete an Appointment of Representative Form if you provide an equivalent written notice or other legal representation document with your request.

How to Appoint a Representative

  • Medicare rules allow you to appoint a representative in the grievance and/or appeals process. Members can contact their local Social Security Office, get help from the local Agency on Aging, or the SOLIS Member Services department.
  • You may appoint any individual (such as a relative, friend, advocate, attorney, physician, and/or other prescriber, or an employee of a pharmacy, charity, or other secondary payer) to act as your legal representative.
  • The appointment is considered valid for one year from the date that the Appointment of Representative Form is signed by both you (the member) and your legal representative.
  • The legal representative has the same rights as the member to the request. They can submit evidence on your behalf.
  • The legal representative may have access to personal information about you.
  • To appoint a legal representative, you must fill out the Appointment of Representative Form (Form CMS-1696).

Instructions for Submitting an Appointment of Representative Form

Members may return the completed form by mail or by fax to:
Fax number: 1-833-615-9263

Mailing Address:
Solis Health Plans
Attn: Grievance and Appeals department
PO Box 524173
Miami, FL 33152

If you have any questions or concerns, please contact our Member Services department at 1-844- 447-6547, TTY 711, from 8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31 and 8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30.