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As a member of CarePlus, this page is just for you. Here you can find the information and forms you need to help manage your healthcare decisions and provide us with feedback.
We want to make it easier for you to help stay in control of your healthcare. As one of our 109,000* members, you are the reason why we work hard to provide you with improved benefits, value and convenience each year. We have always believed that good health care starts with taking good care of your health. That's why we focus on prevention and giving you the benefits you need to help you stay healthier and happier.
*The Centers for Medicare & Medicaid Services (CMS) Medicare Advantage (MA) Membership Reports July 2015
The Overall Star Rating gives you a single summary score that makes it easier for you to compare plans based on quality and performance. The information provided below is an overall star rating for CarePlus’ performance. In addition, you can visit www.medicare.gov (link opens in new window) to see detailed ratings and find out more about the differences between plans.
2016 CMS Star Rating Information
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
CarePlus wants to keep you informed. The Today newsletter is mailed twice a year to CarePlus members and includes helpful information like CMS updates to your plan benefits, recipes, educational and health-related articles and company updates.
The articles in this publication are primarily for educational purposes, and should not be considered specific medical advice. Should any beneficiary feel the need for medical advice, please consult your primary care physician for specific health concerns.
CarePlus' Member Newsletter – "TODAY"
CarePlus' Summary of the Florida Patient's Bill of Rights and Responsibilities
Florida law requires that your healthcare provider or healthcare facility recognize your rights while you are receiving medical care and that you respect the healthcare providers’ or healthcare facility’s right to expect certain behavior on the part of patients.
You or your authorized representative may file a grievance request either orally or in writing. For important information on how to file a grievance, please click one of the options below.
For important information and forms about Coverage Determinations, Redeterminations and how to appoint a representative, please click here.
To file a grievance or appeal, you can contact CarePlus in one of these ways:
By phone– Call CarePlus at 1-800-794-5907; from 8 a.m. to 8 p.m., 7 days a week. From February 15th to September 30th, we are open Monday-Friday from 8 a.m. to 8 p.m. TTY users should call 711.
Fax or mail the form – If you would prefer, you can download a copy of the form below and fax or mail it to CarePlus.
Grievance and Appeals Request Form
Fax number: 1-800-956-4288
CarePlus Health Plans, Inc.
Grievance and Appeals department
11430 NW 20th Street, Suite 300 Miami, FL 33172
You can also file a complaint on the CMS website (link opens in new window)
Contact numbers for members and physicians who have questions and need to inquire about the status of the Grievance, Coverage Determination, and Appeal processes
Please contact the CarePlus Member Services department at 1-800-794-5907; from 8 a.m. to 8 p.m., 7 days a week. From February 15th to September 30th, we are open Monday – Friday from 8 a.m. to 8 p.m. TTY users should call 711. Our fax number is 1-800-956-4288.
Please contact the CarePlus Pharmacy Coverage Determination Review Team at 1-866-315-7587. The Pharmacy Coverage Determination Review Team hours of operations are Monday - Friday, from 8 a.m. to 8 p.m. TTY users should call 711. Our fax number is 1-800-310-9071.
How to Obtain an Aggregate Number of Grievances, Appeals and Exceptions Filed with the Plan
You can also find detailed information in Chapter 9 of the CarePlus Evidence of Coverage (EOC) with regard to grievances, coverage determinations (including exceptions), and the appeals process. Links to the EOC can be found on the 2016 CarePlus Medicare Advantage Plan Information page.
You can submit requests for payment reimbursement, along with proof of payment and a copy of the medial record documentation, if available with your request. To make sure you are giving us all the information we need to make a decision, you can either download a copy of the below Reimbursement Request Form or call Member Services and request the form. The Reimbursement Request Form or signed reimbursement request must be sent in writing.
Mail your request for payment together with any bills, receipts, and/or medical record documentation to us at the address mentioned below:
CarePlus Health Plans, Inc.
11430 NW 20th Street, Suite 300
Miami, FL 33172
Attention: Member Services department
Please note that if your documentation is not in English, you need to provide us with an accurate translation of the documents. Translation services will not be provided by CarePlus.
You can also find detailed information in CarePlus' Evidence of Coverage, under Chapter 7. Section 2.1.
If you are enrolled in a plan that offers OTC allowance, you can take advantage of a monthly allowance amount that you can use to order over-the-counter products. This includes things like cough medicine, pain relievers and first aid items. These products can be mailed directly to your home through our easy-to-use OTC mail-order service. Please allow 10 to 14 calendar days from the time PrescribeIT Rx receives your order to the time of delivery. If you don't receive your order within the estimated timeframe, please call PrescribeIT Rx at 1-800-526-1490.
From time-to-time CMS makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations. You can access the NCD information by using the link below.
CarePlus’ Quality Improvement Program includes clinical care, preventive care and member services. Please click link: CarePlus Quality Improvement Program Description Overview for information about our Quality Improvement Program and progress toward our goals. Members may also obtain a written Quality Improvement (QI) Program description by calling the Quality Operations, Compliance and Accreditation department at (305) 626-5195 between 8:30 a.m. to 5:00 p.m., Monday - Friday; TTY users should call 711. We welcome members’ input regarding our QI program. Feedback can be provided by writing to the following address: CarePlus Health Plans, Inc. Quality Operations, Compliance & Accreditation department, 3501 SW 160th Ave, Bldg. B, 1st Floor Miramar, FL 33027
CarePlus Health Plans, Inc. conducts an annual evaluation of its Model of Care (MOC). If you would like details related to this evaluation please call our Member Services number at 1-800-794-5907; from 8 a.m. to 8 p.m., 7 days a week. From February 15th to September 30th, we are open Monday – Friday from 8 a.m. to 8 p.m. TTY users should call 711.
CareNeeds (HMO SNP), CareNeeds PLUS (HMO SNP), and CareHeart (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2018 based on a review of CareNeeds, CareNeeds PLUS, and CareHeart's Model of Care.