CareSource Downloadable Documents

Summary of Benefits

Enrollment Forms

Formularies

Provider Directory

Pharmacy Directory

Prior Authorization Charts

Evidence of Coverage

Authorization for Release of Health Information

Part D Policy and Procedure Downloads

Plan Selection Form

Low Income Subsidy Chart

Transition Process

Quality Assurance

Voluntary HIV Testing Information

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Summary of Benefits PDF Documents

Douglas County

In Network with Part D - Summary of Benefits
In Network without Part D - Summary of Benefits
Preferred Provider with Part D - Summary of Benefits
Preferred Provider without Part D - Summary of Benefits

Jackson County

In Network with Part D - Summary of Benefits
In Network without Part D - Summary of Benefits
Preferred Provider with Part D - Summary of Benefits
Preferred Provider without Part D - Summary of Benefits

Josephine County

In Network with Part D - Summary of Benefits
In Network without Part D - Summary of Benefits
Preferred Provider with Part D - Summary of Benefits
Preferred Provider without Part D - Summary of Benefits

Special Needs Plan

CareSource SNP (Special Needs Plan)

CareSource SNP Curry County (Special Needs Plan)

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Enrollment Forms (Download and Print)

CareSource Plan Enrollment Form - PDF (All plans except SNP)

CareSource SNP (Special Needs Plan) Enrollment Form (SNP)

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Formularies

2010 CareSource Plus Rx Formulary

    CareSource Plus Rx Searchable Formulary Tool

2010 CareSource SNP Formulary (SNP Formulary)

    CareSource SNP Searchable Formulary Tool

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Provider Directory

Provider Directory

Pharmacy Directory

Pharmacy Directory

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Prior Authorization Charts

Plus Rx Prior Authorization Drugs

Special Needs Plan – Prior Authorization Drugs

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Evidence of Coverage

CareSource Evidence of Coverage - Silver

CareSource Evidence of Coverage - Gold

CareSource Evidence of Coverage - Platinum

CareSource Evidence of Coverage - Diamond

CareSource Evidence of Coverage - Silver Plus Rx

CareSource Evidence of Coverage - Gold Plus Rx

CareSource Evidence of Coverage - Platinum Plus Rx

CareSource Evidence of Coverage - Diamond Plus Rx

CareSource Evidence of Coverage - SNP (Special Needs Plan)

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Authorization for Release of Health Information

Authorization for Release of Health Information - Word version

Authorization for Release of Health Information - PDF version

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Part D Policy and Procedure Downloads

Section 3.2.4 A5 MTM Program (Medication Therapy Management)

Part D Determination and Appeal Policy

Part D Exception Process & Formulary Change Policy

Part D Expedited Appeal (Redetermination) Process Policy

Part D Expedited Drug Coverage Process Policy

Part D Grievance Policy & Procedure

Part D Formulary Tier Changing Policy

Part D Standard Reconsideration Policy

Part D Expedited Redetermination Process

Part D Standard Drug Coverage Process

Part D Standard Redetermination Process

Part D Transition Policy - Word Version

Part D Transition Policy - PDF Version

Plan Selection Form

Plan Selection Form (For changing your CareSource plan)

Low Income Subsidy

Low Income Subsidy Chart

Plan Transition Process – Part D Drugs

Transition Process

Quality Assurance

Quality Assurance Program Description

Voluntary HIV Testing Information

Voluntary HIV Testing Information