Medicare’s Star Rating for
CarePlus Health Plans
Member Resources
Access important forms and documents about plans, pharmacy, benefits, and more.
Medicare’s Star Rating for
English 2025 CarePlus Enrollment Form PDF opens in new window Spanish 2025 CarePlus Enrollment Form PDF opens in new window English 2024 Enrollment Form PDF opens in new window Spanish 2024 Enrollment Form PDF opens in new window English Reimbursement Request Form PDF opens in new window Spanish Reimbursement Request Form PDF opens in new window
English Dental Benefits Claim Form PDF opens in new window Spanish Dental Benefits Claim Form PDF opens in new window English Grievance or Appeal Request Form PDF opens in new window Spanish Grievance or Appeal Request Form PDF opens in new window English Request for Alternate Communications PDF opens in new window Spanish Request for Alternate Communications PDF opens in new window
English 2025 Centerwell Pharmacy OTC Mail-Order Form PDF opens in new window Spanish 2025 Centerwell Pharmacy OTC Mail-Order Form PDF opens in new window English 2024 CenterWell Pharmacy™ OTC Mail-Order Form PDF opens in new window Spanish 2024 CenterWell Pharmacy™ OTC Mail-Order Form PDF opens in new window English Part D Coverage Determination Request Form PDF opens in new window Spanish Part D Coverage Determination Request Form PDF opens in new window English Prescription Drug Claim Form PDF opens in new window
Spanish Prescription Drug Claim Form PDF opens in new window English 2025 Part B Step Therapy Preferred Drug List PDF opens in new window Spanish 2025 Part B Step Therapy Preferred Drug List PDF opens in new window English 2024 Part B Step Therapy Preferred Drug List PDF opens in new window Spanish 2024 Part B Step Therapy Preferred Drug List PDF opens in new window Printable English Medication List PDF opens in new window Printable Spanish Medication List PDF opens in new window English Request for Redetermination of Medicare Prescription Drug Denial Form PDF opens in new window Spanish Request for Redetermination of Medicare Prescription Drug Denial Form PDF opens in new window
English Appointment of Representative Form PDF opens in new window Spanish Appointment of Representative Form PDF opens in new window English Consent for Release of PHI Form PDF opens in new window Spanish Consent for Release of PHI Form PDF opens in new window English Revocation of Consent for Release of PHI Form PDF opens in new window Spanish Revocation of Consent for Release of PHI Form PDF opens in new window English Request for Accounting of Disclosures PDF opens in new window Spanish Request for Accounting of Disclosures PDF opens in new window English Privacy Complaint Form PDF opens in new window Spanish Privacy Complaint Form PDF opens in new window
Request Printed Materials
If you’re a CarePlus member, you can request a printed copy of our Evidence of Coverage, Provider Directory, or Prescription Drug Guide.
