Online Membership Inquiry

Request for Information about Amida Care Enrollment

As always, we respect your privacy and will not share your information.

Please note, the starred fields ( * ) are required information.

First Name:*

Last Name:*

CIN #:

DOB:

Street and Number:

City (NY only):*

ZIP:*

Home Phone:*

Cell Phone :

Alternate Phone:

Email:*

Best time to contact me is:

I agree that an Amida Care representative may contact me as follows:

By Phone at the numbers noted above*

Yes

Message may be left on answering machine:

Yes

Message may be left with another individual who answers the telephone:

Yes

NOTE: An Amida Care representative will not mention Amida Care in the message,
but will identify themselves by name and say they are with a health plan.

By Mail at the address noted above:

Yes

NOTE: Amida Care is not listed on the return address on the envelope.

Amida Care is an NYS sponsored HIV Special Needs Plan (SNP) that provides health care services for people on Medicaid living with HIV and their children. Amida Care services Manhattan, Brooklyn, the Bronx and Staten Island. Starting September 1, 2010, if you live in New York City, choosing a Special Needs Plan or a regular Medicaid managed care plan is mandatory for PLWHA. To learn more about HIV SNPs, call NY Medicaid CHOICE helpline at 1-800-505-5678. (TTY 1-888-329-1541)

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