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Member Handbooks and Forms

This handbook tells you how Nebraska Total Care works and the services we offer. Your Member Handbook includes:

  • Information about your benefits
  • Your rights and responsibilities
  • Member satisfaction
  • How to choose your Primary Care Provider (PCP)
  • When to use urgent care instead of the emergency room

Please take time to look over your handbook. Keep it handy in case you need it. You have the option to receive this handbook at least once a year. You can get it in either an electronic or a paper format. You can always see it here on our website. 

Nebraska Total Care Member Handbook (PDF)

A screen reader may be used to translate visual information verbally. NVDA is a free, open source, globally accessible screen reader for the blind and vision impaired. The NVDA screen reader can be downloaded free of charge by anyone.  Get the NVDA User Guide.

Grievance and Appeals Forms

These forms can be used to file a grievance or appeal. Information about where to send it is on the form. More information about these processes can be found on our Complaints and Appeals page.

HIPAA Forms

Other Forms

  • Health Information Form (PDF) - This form will help us find out if there are any extra information or services you need. You can complete the form in the Member Portal or it can be mailed to:

    Medical Management Notifications
    PO Box 2010
    Farmington, MO  63640-9706

  • Notice of Pregnancy (PDF) - This form will help us give you extra information and support you need during and after pregnancy. You can complete the form in the Member Portal or it can be mailed to:

    Medical Management Notifications
    PO Box 2010
    Farmington, MO  63640-9706

  • Primary Care Provider Change Form (PDF) - This form tells us that you want to change your Primary Care Provider. You can change your Primary Care Provider in the Member Portal or mail this form to:

    Nebraska Total Care
    2525 N 117th Ave, Suite 100
    Omaha, NE 68164

Nebraska Total Care can help

If you need help understanding your Member Handbook or completing these forms, please call Member Services. The phone number is 1-844-385-2192 (TDD/TTY: 1-844-307-0342, Relay 711)