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*
Message may be left on answering machine:
Message may be left with another individual who answers the telephone:

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:

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

Amida Care is an NYS sponsored HIV Special Needs Plan that provides health care for people on Medicaid living with HIV, and for their children. Amida Care services Manhattan, Brooklyn, and the Bronx. Joining an HIV SNP is voluntary. To learn about HIV SNPs, call the New York Medicaid CHOICE Helpline at 1-800-505-5678. (TTY/TDD 1-888-329-1541)

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