File an Allegation
 
After the allegation is received, Elderplan will evaluate it and take appropriate action. If you submit your name and contact information on the allegation, you will receive an acknowledgment from Elderplan.

Unless you have chosen to file your allegation anonymously, you may be contacted to verify details of the complaint or to provide additional information.
   
Your Contact Information  
   
First Name
Mi
Last Name
Suffix
Address #1
Address #2
City
State
Zipcode
Telephone #
Email Address
Provider ID (if applicable)
Member ID (if applicable)
   
Select the Allegation Type
Please enter only a Provider Allegation or a Member Allegation. If you have a provider and a member allegation, please complete a separate allegation form for each
 
Nature of Allegation
Allegation*
 
 
When you click the Submit button, a Confirmation Page will appear. Please print a copy of the Confirmation Page for your records.
 
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