Appeals and Grievances

To file a reconsideration of the plan’s decision about your medical care coverage, you can use our Member Appeal & Grievance Form. This form, along with any documentation to support your appeal or grievance, can be submitted by mail, fax or phone to:

Vibra Health Plan 
ATTN: Appeals & Grievances 
PO Box 60250 
Harrisburg, PA 17106-0250 
Fax: 844.774.5585
Phone: 844.388.8268 (TTY 711)

To file a redetermination of the plan’s decision about your Part D drug coverage, you can use our Redetermination Request Form. This form, along with any documentation to support your appeal, can be submitted by mail, fax or phone to:

Prime Therapeutics, LLC 
Attention: Medicare Appeals Department 
1305 Corporate Center Drive 
Building N10 
Eagan, MN 55121 
Fax: 800.693.6703 
Phone: 855.457.1352 (TTY 711)

If your health requires a quick response, you should ask us to make a "fast appeal", also known as an "expedited reconsideration". You, your doctor, or your representative can request a "fast appeal" by contacting us at the address, fax, or phone number listed above.