The links below will take you to the enrollment form that may be printed in advance, and will also be provided by the benefit consultant should you decide to enroll.

Enrollment Form for CY 2008
Enrollment Form for CY 2009

Please remember that if you are already enrolled in CarePlus Health Plans, Inc. Medicare Advantage Plan, you may not enroll in a stand-alone Part D plan (PDP). Enrollment into a PDP plan will automatically disenroll you from your CarePlus Health Plans, Inc. Medicare Advantage Plan.

CarePlus Health Plans, Inc. is a Medicare Advantage Organization with a Medicare contract. You must be enrolled in Medicare Part B and entitled to Part A. You must reside in the service area of the plan. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third-party.

Potential for Contract Termination
Beneficiaries’ and Plan’s Rights and Responsibilities Upon Disenrollment

Exceptions, Grievance, and Appeals Information

• Grievance, Exceptions, Coverage Determinations and Appeals Procedures 
• Request for Medicare Prescription Drug Coverage Determination Form and Instructions 
• Medicare Redetermination Request Form and Instructions 
• Grievance Form  
• Instructions for completing and submitting the Grievance Form  
• Appointment of Representative Form (CMS Form 1696) 
• Appointment of Representative Form: Instructions on how to appoint a representative and How to submit the Form 
• Prior Authorization/Medical Exception Form (Provider Use Only) 
• Instructions for completing and submitting the Prior Authorization/Medical Exception Form 
• Contact numbers for Enrollees and Physicians who have Questions and need to Inquire about the status of the Grievance, Coverage Determination and Appeal processes
• How to Obtain an Aggregate Number of Grievances, Appeals and Exceptions Filed with the Plan

For the CarePlus Health Plans, Inc. Benefit Plans (MA-PD Plans) that have Medicare Part D Prescription Drug Benefits Coverage, please go to Sections 4 & 5 of the Evidence of Coverage (EOC). These sections provide detailed information about the Grievance, Coverage Determination (including exceptions), and Appeal processes that it may be beneficial when requesting or filing one of the above forms.

Learn more about CarePlus Health Plans, Inc.’s Medicare Advantage HMO plans by calling: 1-800-793-9808. We are open from 8:00 a.m. to 8:00 p.m., 7 days a week. You may leave us a voice mail message after-hours, Saturdays, Sundays, and holidays, and we will return your call the next business day. TTY number for the hearing and speech impaired, call: 1-877-245-7930

This Website is for individual Medicare coverage only.

CarePlus Health Plans, Inc. is a Medicare Advantage Organization with a Medicare contract. You must be enrolled in Medicare Part B and entitled to Part A. You must reside in the service area of the Plan. You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party. Some limitations, restrictions, coinsurance, and copayments may apply.

For Access to Exceptions, Grievance, Appeals, and Coverage Determinations/Redeterminations Information , please see our  Forms  page.

Click here if you have problems viewing documents on this website.

The information in these pages is accurate as of 11/1/2008, and is subject to change without notice.

CMS: H1019_CPHP_2008_Website REV 5 - APPVD 11/10/2008