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Call us to learn more about CareSource: Toll-free 1-888-460-0185
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Paper Enrollment Forms
Currently, there are 2 ways to enroll from this web site. One way is to download an enrollment form in PDF format, fill in the blank spaces, print it, and mail it in to us. The other it so submit your enrollment online. You will need Adobe Reader to use the downloadable form.
The other way is to fill out our online enrollment form. When you submit the online enrollment form, it will be sent directly to us electronically. The choice is yours.
Paper Enrollment
Download CareSource General Enrollment Form (For all plans except SNP)
CareSource 740 S.E. 7th Street, Grants Pass, O.R. 97526
Brokers/agents please use the enrollment form found here
Download CareSource SNP Enrollment Form - Form 7208M for SNP (State Case Workers only)
Easy Pay electronic funds transfer is also available. Please use this form.
Forms
Please use this form if you are a member and you wish to change your CareSource plan.
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