Members Resources

Find tools, information, and other resources to help you get the most out of your benefits

Appoint a Representative to File a Grievance

You or someone you name may file a complaint (grievance) or appeal for you. The person you name would be your “appointed representative”. You may name a relative, friend, lawyer, advocate, health care provider, or anyone else to act on your behalf.

To appoint a representative, fill out CMS Appointment of Representative Form (CMS Form-1696).

Print and mail the form to:

Simpra Advantage
Appeals and Grievances Department
PO Box 2190
Glen Allen, VA 23058

You may also send a fax to 1-833-610-2380

For a description of, and information on how to appoint a representative, you may also call Member Services at 1-844-637-4770 (TTY 711).