Browse and download the forms CarePlus members use most often.

• Bilingual Provider Directories (2019)
• 2019 Annual Notice of Change
• 2019 Prescription Drug Guides
• 2019 Summary of Benefits and Evidence of Coverage

• PDFAppointment of Representative Form – English(PDF opens in new window) 
• PDFAppointment of Representative Form – Spanish(PDF opens in new window) 
• PDFConsent for Release of PHI – English(PDF opens in new window) 
• PDFConsent for Release of PHI – Spanish(PDF opens in new window) 
• PDFGrievance/Appeal Request Form – English(PDF opens in new window) 
• PDFGrievance/Appeal Request Form – Spanish(PDF opens in new window) 
• PDFReimbursement Request Form – English(PDF opens in new window) 
• PDFReimbursement Request Form – Spanish(PDF opens in new window) 

• PDF2019 PrescribeIT Rx OTC English order form(PDF opens in new window) 
• PDF2019 PrescribeIT Rx OTC Spanish order form(PDF opens in new window) 

• Medication Therapy Management
• Part D Coverage Determination Request – English(PDF opens in new window) 
• Part D Coverage Determination Request –Spanish(PDF opens in new window) 

• PDFPrescription Drug Claim Form – English(PDF opens in new window) 
• PDFPrescription Drug Claim Form - Spanish(PDF opens in new window) 

Prescription Drug Coverage Information

• Find a Provider
  Quickly find a physician, hospital, dentist, vision provider, or pharmacy by location, name, specialty, or condition. You can compare doctors, find out if they are accepting new patients, and get their address, along with directions.
• 24-hour Nurse Advice Line

• Flu Vaccine
• Living Healthy
• CarePlus Rewards
• SilverSneakers^®

• PDFPreventive Screening Guidelines - English(PDF opens in new window) 
• PDFPreventive Screening Guidelines - Spanish(PDF opens in new window)