{"id":170777,"date":"2015-07-07T14:43:00","date_gmt":"2015-07-07T21:43:00","guid":{"rendered":"https:\/\/www.hometownhealth.com\/servicio-y-asistencia-a-los-afiliados\/formularios-de-afiliacion\/"},"modified":"2025-06-05T15:55:26","modified_gmt":"2025-06-05T22:55:26","slug":"formularios-de-afiliacion","status":"publish","type":"page","link":"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/formularios-de-afiliacion\/","title":{"rendered":"Formularios de afiliaci\u00f3n"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"170777\" class=\"elementor elementor-170777 elementor-3674\" data-elementor-settings=\"{&quot;element_pack_global_tooltip_width&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_width_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;element_pack_global_tooltip_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;element_pack_global_tooltip_border_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true}}\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-60fce74 e-con-full e-flex e-con e-parent\" data-id=\"60fce74\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-1c46170 e-con-full e-flex e-con e-child\" data-id=\"1c46170\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-6a86302 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"6a86302\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Formularios de afiliaci\u00f3n<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cdebb65 elementor-widget elementor-widget-text-editor\" data-id=\"cdebb65\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h4><em>Servicio y asistencia a los afiliados<\/em><\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-48b5ec6 e-con-full e-flex e-con e-child\" data-id=\"48b5ec6\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-74bd9a2 e-flex e-con-boxed e-con e-parent\" data-id=\"74bd9a2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-c1e344f e-con-full e-flex e-con e-child\" data-id=\"c1e344f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-1902365 e-con-full e-flex e-con e-child\" data-id=\"1902365\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-acc3268 e-con-full e-flex e-con e-child\" data-id=\"acc3268\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f152648 elementor-widget elementor-widget-text-editor\" data-id=\"f152648\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h5><strong>Derecho de acceso<\/strong><\/h5><p>Si un miembro actual desea autorizar a Hometown Health a utilizar y\/o divulgar la informaci\u00f3n m\u00e9dica y sanitaria del miembro a un representante personal, el miembro debe rellenar este formulario y enviarlo a Hometown Health.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-815981b elementor-widget elementor-widget-eael-creative-button\" data-id=\"815981b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-creative-button.default\">\n\t\t\t\t\t        <div class=\"eael-creative-button-wrapper\">\n\n            <a class=\"eael-creative-button eael-creative-button--default eael-cb-icon-position-\" href=\"https:\/\/www.hometownhealth.com\/wp-content\/uploads\/2025\/02\/10936HTH_3285498_2025_SCP_HIPAA_RightOfAccess_Form_MECH2.pdf\" data-text=\"\u00a1Vamos!\" data-wpel-link=\"external\" rel=\"external noopener noreferrer\">\n            \t    \n                <div class=\"creative-button-inner\">\n\n                    \n                    <span class=\"cretive-button-text\">Derecho de acceso<\/span>\n\n                                    <\/div>\n\t                        <\/a>\n        <\/div>\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-ad032bb e-con-full e-flex e-con e-child\" data-id=\"ad032bb\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d0e643f elementor-widget elementor-widget-text-editor\" data-id=\"d0e643f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h5><strong>Formulario de solicitud de continuidad asistencial<\/strong><\/h5><p>Utiliza este formulario para solicitar una ampliaci\u00f3n de la asistencia de tu profesional sanitario actual si ha abandonado la red del plan de salud y ahora se le considera fuera de la red.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-162b76d elementor-widget elementor-widget-eael-creative-button\" data-id=\"162b76d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-creative-button.default\">\n\t\t\t\t\t        <div class=\"eael-creative-button-wrapper\">\n\n            <a class=\"eael-creative-button eael-creative-button--default eael-cb-icon-position-\" href=\"https:\/\/www.hometownhealth.com\/wp-content\/uploads\/2022\/06\/HTH-Continuity-of-Care-Request-Form-Final_Form.pdf\" data-text=\"\u00a1Vamos!\" data-wpel-link=\"external\" rel=\"external noopener noreferrer\">\n            \t    \n                <div class=\"creative-button-inner\">\n\n                    \n                    <span class=\"cretive-button-text\">Formulario de solicitud de continuidad asistencial<\/span>\n\n                                    <\/div>\n\t                        <\/a>\n        <\/div>\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-e29ef44 e-con-full e-flex e-con e-child\" data-id=\"e29ef44\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-4915db7 e-con-full e-flex e-con e-child\" data-id=\"4915db7\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2c71f90 elementor-widget elementor-widget-text-editor\" data-id=\"2c71f90\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h5><strong>Formulario de solicitud de reembolso<\/strong><\/h5><p>Utiliza este formulario para el reembolso de gastos de reclamaciones de bolsillo. Desc\u00e1rgate el formulario, lee las instrucciones y rellena el anverso del formulario. Tendr\u00e1s que hacer que el m\u00e9dico o el centro rellenen el reverso del formulario. Una vez cumplimentado, env\u00edalo al departamento de Atenci\u00f3n al Cliente de Hometown Health siguiendo las instrucciones del Departamento de Reclamaciones por correo electr\u00f3nico a <a href=\"mailto:Customer_Service@hometownhealth.com\">Customer_Service@hometownhealth.com<\/a> o por fax al 775-982-3751.   <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1185bce elementor-widget elementor-widget-eael-creative-button\" data-id=\"1185bce\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-creative-button.default\">\n\t\t\t\t\t        <div class=\"eael-creative-button-wrapper\">\n\n            <a class=\"eael-creative-button eael-creative-button--default eael-cb-icon-position-\" href=\"https:\/\/www.hometownhealth.com\/wp-content\/uploads\/2025\/02\/10936HTH_3352047_HTH_SCP_Reimbursement_Claim_Form_MECH2.pdf\" data-text=\"\u00a1Vamos!\" data-wpel-link=\"external\" rel=\"external noopener noreferrer\">\n            \t    \n                <div class=\"creative-button-inner\">\n\n                    \n                    <span class=\"cretive-button-text\">Formulario de solicitud de reembolso<\/span>\n\n                                    <\/div>\n\t                        <\/a>\n        <\/div>\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-97c6855 e-con-full e-flex e-con e-child\" data-id=\"97c6855\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-868db60 elementor-widget elementor-widget-text-editor\" data-id=\"868db60\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h5><strong>Formulario de Reclamaci\u00f3n de Medicamentos Recetados Optum Rx Commercial<\/strong><\/h5><p>Si un afiliado actual necesita solicitar el reembolso de una receta que pag\u00f3 de su bolsillo, deber\u00e1 cumplimentar este formulario. Una vez cumplimentado, env\u00eda el formulario con el recibo o recibos de farmacia a: <strong>Optum Rx Claims Department, PO Box 650629, Dallas, TX 75265-0629<\/strong> <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-db51eb9 elementor-widget elementor-widget-eael-creative-button\" data-id=\"db51eb9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-creative-button.default\">\n\t\t\t\t\t        <div class=\"eael-creative-button-wrapper\">\n\n            <a class=\"eael-creative-button eael-creative-button--default eael-cb-icon-position-\" href=\"https:\/\/www.hometownhealth.com\/wp-content\/uploads\/2024\/03\/Optum-RX-Reimbursement-Claim-Form.pdf\" data-text=\"\u00a1Vamos!\" data-wpel-link=\"external\" rel=\"external noopener noreferrer\">\n            \t    \n                <div class=\"creative-button-inner\">\n\n                    \n                    <span class=\"cretive-button-text\">Formulario de Reclamaci\u00f3n de Medicamentos Recetados Optum Rx Commercial<\/span>\n\n                                    <\/div>\n\t                        <\/a>\n        <\/div>\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-9443019 e-con-full e-flex e-con e-child\" data-id=\"9443019\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-a1f1a5d e-con-full e-flex e-con e-child\" data-id=\"a1f1a5d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-98837f5 elementor-widget elementor-widget-text-editor\" data-id=\"98837f5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h5><strong>Formulario de designaci\u00f3n de m\u00e9dico - HMO y PPO<\/strong><\/h5><p>Si tu m\u00e9dico no est\u00e1 en nuestra red, puedes proponerlo para que lo tengamos en cuenta. Haz clic en el formulario de la red correspondiente y sigue las instrucciones para enviarlo. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-15f6065 elementor-widget elementor-widget-eael-creative-button\" data-id=\"15f6065\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-creative-button.default\">\n\t\t\t\t\t        <div class=\"eael-creative-button-wrapper\">\n\n            <a class=\"eael-creative-button eael-creative-button--default eael-cb-icon-position-\" href=\"https:\/\/www.hometownhealth.com\/wp-content\/uploads\/2022\/08\/Provider-Nomination-form-HMO.pdf\" data-text=\"\u00a1Vamos!\" data-wpel-link=\"external\" rel=\"external noopener noreferrer\">\n            \t    \n                <div class=\"creative-button-inner\">\n\n                    \n                    <span class=\"cretive-button-text\">Formulario de designaci\u00f3n de m\u00e9dico - HMO<\/span>\n\n                                    <\/div>\n\t                        <\/a>\n        <\/div>\n        \t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7581d1f elementor-widget elementor-widget-eael-creative-button\" data-id=\"7581d1f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"eael-creative-button.default\">\n\t\t\t\t\t        <div class=\"eael-creative-button-wrapper\">\n\n            <a class=\"eael-creative-button eael-creative-button--default eael-cb-icon-position-\" href=\"https:\/\/www.hometownhealth.com\/wp-content\/uploads\/2022\/08\/Provider-Nomination-form-PPO.pdf\" data-text=\"\u00a1Vamos!\" data-wpel-link=\"external\" rel=\"external noopener noreferrer\">\n            \t    \n                <div class=\"creative-button-inner\">\n\n                    \n                    <span class=\"cretive-button-text\">Formulario de designaci\u00f3n de m\u00e9dico - PPO<\/span>\n\n                                    <\/div>\n\t                        <\/a>\n        <\/div>\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-706a102 e-con-full e-flex e-con e-child\" data-id=\"706a102\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f669d68 elementor-widget elementor-widget-text-editor\" data-id=\"f669d68\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<h4 class=\"masthead__sub-title\" style=\"text-align: center;\">\u00bfNo encuentras lo que necesitas?<\/h4><p class=\"masthead__sub-title\" style=\"text-align: center;\"><strong>Ll\u00e1manos al <a href=\"tel:800-336-0123\" data-wpel-link=\"internal\">800-336-0123<\/a><\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6f4d56d elementor-hidden-tablet elementor-hidden-mobile e-flex e-con-boxed e-con e-parent\" data-id=\"6f4d56d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-4d40dea e-con-full e-flex e-con e-child\" data-id=\"4d40dea\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e3cb198 elementor-widget elementor-widget-heading\" data-id=\"e3cb198\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Recursos de apoyo a los afiliados<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cbb972c elementor-hidden-mobile elementor-nav-menu__align-start elementor-widget__width-initial elementor-nav-menu--dropdown-tablet elementor-nav-menu__text-align-aside elementor-nav-menu--toggle elementor-nav-menu--burger elementor-widget elementor-widget-nav-menu\" data-id=\"cbb972c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;layout&quot;:&quot;horizontal&quot;,&quot;submenu_icon&quot;:{&quot;value&quot;:&quot;&lt;svg aria-hidden=\\&quot;true\\&quot; class=\\&quot;e-font-icon-svg e-fas-caret-down\\&quot; viewBox=\\&quot;0 0 320 512\\&quot; xmlns=\\&quot;http:\\\/\\\/www.w3.org\\\/2000\\\/svg\\&quot;&gt;&lt;path d=\\&quot;M31.3 192h257.3c17.8 0 26.7 21.5 14.1 34.1L174.1 354.8c-7.8 7.8-20.5 7.8-28.3 0L17.2 226.1C4.6 213.5 13.5 192 31.3 192z\\&quot;&gt;&lt;\\\/path&gt;&lt;\\\/svg&gt;&quot;,&quot;library&quot;:&quot;fa-solid&quot;},&quot;toggle&quot;:&quot;burger&quot;}\" data-widget_type=\"nav-menu.default\">\n\t\t\t\t\t\t\t\t<nav aria-label=\"Menu\" class=\"elementor-nav-menu--main elementor-nav-menu__container elementor-nav-menu--layout-horizontal e--pointer-framed e--animation-fade\">\n\t\t\t\t<ul id=\"menu-1-cbb972c\" class=\"elementor-nav-menu\"><li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-home menu-item-173645\"><a href=\"https:\/\/www.hometownhealth.com\/es\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Inicio<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173646\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Servicio y asistencia a los afiliados<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173647\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/eres-nuevo-en-hometown-health-empecemos\/\" class=\"elementor-item\" data-wpel-link=\"internal\">\u00bfEres nuevo en Hometown Health? Empecemos<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173648\"><a href=\"https:\/\/www.hometownhealth.com\/es\/farmacia\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Farmacia<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173649\"><a href=\"https:\/\/www.hometownhealth.com\/es\/mychart\/\" class=\"elementor-item\" data-wpel-link=\"internal\">MyChart<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173650\"><a href=\"https:\/\/www.hometownhealth.com\/es\/para-los-empresarios\/beneficios-oftalmologicos-para-empresas\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Beneficios oftalmol\u00f3gicos para empresas<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173651\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/formularios-de-afiliacion\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Formularios de afiliaci\u00f3n<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173652\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/tu-tarjeta-de-afiliacion\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Tu Tarjeta de Afiliaci\u00f3n<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173653\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/procedimiento-de-reclamacion-de-los-afiliados\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Procedimiento de reclamaci\u00f3n de los afiliados<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173654\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/derechos-y-responsabilidades-de-los-afiliados\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Derechos y responsabilidades de los afiliados<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173655\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/afiliacion-y-elegibilidad-de-los-dependientes\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Afiliaci\u00f3n y elegibilidad de los dependientes<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173656\"><a href=\"https:\/\/www.hometownhealth.com\/es\/salud-mental\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Salud mental<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173657\"><a href=\"https:\/\/www.hometownhealth.com\/es\/directorios-de-proveedores\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Directorios de proveedores<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173658\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/acontecimientos-vitales-que-cumplen-los-requisitos\/\" class=\"elementor-item\" data-wpel-link=\"internal\">Acontecimientos vitales que cumplen los requisitos<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t<div class=\"elementor-menu-toggle\" role=\"button\" tabindex=\"0\" aria-label=\"Alternar men\u00fa\" aria-expanded=\"false\">\n\t\t\t<svg aria-hidden=\"true\" role=\"presentation\" class=\"elementor-menu-toggle__icon--open e-font-icon-svg e-eicon-menu-bar\" viewBox=\"0 0 1000 1000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M104 333H896C929 333 958 304 958 271S929 208 896 208H104C71 208 42 237 42 271S71 333 104 333ZM104 583H896C929 583 958 554 958 521S929 458 896 458H104C71 458 42 487 42 521S71 583 104 583ZM104 833H896C929 833 958 804 958 771S929 708 896 708H104C71 708 42 737 42 771S71 833 104 833Z\"><\/path><\/svg><svg aria-hidden=\"true\" role=\"presentation\" 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menu-item-type-post_type menu-item-object-page menu-item-173646\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Servicio y asistencia a los afiliados<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173647\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/eres-nuevo-en-hometown-health-empecemos\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">\u00bfEres nuevo en Hometown Health? Empecemos<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173648\"><a href=\"https:\/\/www.hometownhealth.com\/es\/farmacia\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Farmacia<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173649\"><a href=\"https:\/\/www.hometownhealth.com\/es\/mychart\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">MyChart<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173650\"><a href=\"https:\/\/www.hometownhealth.com\/es\/para-los-empresarios\/beneficios-oftalmologicos-para-empresas\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Beneficios oftalmol\u00f3gicos para empresas<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173651\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/formularios-de-afiliacion\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Formularios de afiliaci\u00f3n<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173652\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/tu-tarjeta-de-afiliacion\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Tu Tarjeta de Afiliaci\u00f3n<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173653\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/procedimiento-de-reclamacion-de-los-afiliados\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Procedimiento de reclamaci\u00f3n de los afiliados<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173654\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/derechos-y-responsabilidades-de-los-afiliados\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Derechos y responsabilidades de los afiliados<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173655\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/afiliacion-y-elegibilidad-de-los-dependientes\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Afiliaci\u00f3n y elegibilidad de los dependientes<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173656\"><a href=\"https:\/\/www.hometownhealth.com\/es\/salud-mental\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Salud mental<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173657\"><a href=\"https:\/\/www.hometownhealth.com\/es\/directorios-de-proveedores\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Directorios de proveedores<\/a><\/li>\n<li class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-173658\"><a href=\"https:\/\/www.hometownhealth.com\/es\/servicio-y-asistencia-a-los-afiliados\/acontecimientos-vitales-que-cumplen-los-requisitos\/\" class=\"elementor-item\" tabindex=\"-1\" data-wpel-link=\"internal\">Acontecimientos vitales que cumplen los requisitos<\/a><\/li>\n<\/ul>\t\t\t<\/nav>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Formularios de afiliaci\u00f3n Servicio y asistencia a los afiliados Derecho de acceso Si un miembro actual desea autorizar a Hometown Health a utilizar y\/o divulgar la informaci\u00f3n m\u00e9dica y sanitaria del miembro a un representante personal, el miembro debe rellenar este formulario y enviarlo a Hometown Health. Derecho de acceso Formulario de solicitud de continuidad [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":170733,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_seopress_titles_title":"","_seopress_titles_desc":"Accede a los formularios esenciales para afiliados en Hometown Health para una gesti\u00f3n del seguro sin problemas. Descarga c\u00f3modamente online formularios para reclamaciones, inscripci\u00f3n y mucho m\u00e1s. 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