Request a printed copy of an Evidence of Coverage, Provider Directory or Prescription Drug Guide

Fill out the form below to request a copy of our printed Evidence of Coverage, Bilingual Provider Directory, and/or Prescription Drug Guide for a specific CarePlus benefit plan and service area/county. In order to receive the correct document, please enter the contract and plan benefit package (PBP) number for the plan you’re interested in receiving. For example, H1019-054.

To find the contract and Plan Benefit Package (PBP) or plan number:

  1. Go to
  2. Enter your ZIP code to find a plan.
  3. Browse the list of plans for your ZIP code.
  4. View the name of the plan, such as "CareOne PLUS (HMO)."
  5. Locate the contract and PBP number underneath the name of the plan, as shown in the image.

For immediate access to current information about our provider network, we recommend using our online searchable directory.

We collect your name and mailing address only to use when sending you the requested materials, and not for any other purpose.

Required All fields are required.

Required Please choose the printed materials you would like to receive in the mail. Future year documents are available by 10/1 of the current year.

CarePlus is an HMO plan with a Medicare contract. Enrollment in CarePlus depends on contract renewal.

The formulary, pharmacy, and/or provider networks may change at any time. You will receive notice when necessary.