The link below will take you to the CarePlus Enrollment Form that may be printed in advance before you make an appointment with one of our benefit consultants. This form may also be provided by the benefit consultant, if you should decide to enroll.

Enrollment Form for CY 2010
Enrollment Form for CY2010 - Spanish Version

Please remember that if you are already enrolled in one of the CarePlus Health Plans, Inc. Medicare Advantage HMO benefit plans, 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 HMO 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. Some limitations, restrictions, coinsurance, and copayments may apply.

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  
• Grievance Form - Spanish Version  
• 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

Learn more about CarePlus Health Plans, Inc.’s Medicare Advantage HMO plans by calling: 1-800-793-9808. We are open Monday through Friday, 8:00 a.m. to 8:00 p.m. From March 2, 2010, until the following Annual Election Period (AEP), 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.

The documents that appear in this website are available in alternate format.

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

The information in these pages is accurate as of 1/1/2010, and is subject to change without notice.

CMS: H1019_CPHP_2008_Website REV 10 (APVD 03/11/10)